Healthcare Provider Details

I. General information

NPI: 1457703399
Provider Name (Legal Business Name): TIFFANY CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2016
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HARDING PIKE
NASHVILLE TN
37205-2005
US

IV. Provider business mailing address

509 S EUCLID AVE
SAINT LOUIS MO
63110-1007
US

V. Phone/Fax

Practice location:
  • Phone: 615-298-4100
  • Fax: 615-298-4141
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2016014427
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number64001
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: