Healthcare Provider Details

I. General information

NPI: 1780982991
Provider Name (Legal Business Name): TIFFANY GINGER MAY LIEAN HEU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 COLEGATE DR EMERGENCY DEPARTMENT
MARIETTA OH
45750
US

IV. Provider business mailing address

PO BOX 449
MARIETTA OH
45750-0449
US

V. Phone/Fax

Practice location:
  • Phone: 740-568-2000
  • Fax: 740-568-2096
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A13658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: