Healthcare Provider Details

I. General information

NPI: 1811488703
Provider Name (Legal Business Name): TIFFANY LAUREN BRAZILE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY LAUREN BARBARASH MD

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR STE 700
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-2900
  • Fax: 571-472-2901
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: