Healthcare Provider Details

I. General information

NPI: 1932312642
Provider Name (Legal Business Name): TIFFANY LANE BARTSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY LANE RADOMSKY MD

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 5TH AVENUE
SPOKANE WA
99204
US

IV. Provider business mailing address

PO BOX 8500 LOCKBOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-7844
  • Fax: 509-623-0415
Mailing address:
  • Phone: 813-281-8115
  • Fax: 813-281-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA102310
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD439337
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60449879
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: