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General NPI Number Information
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NPI Number | 1265016141
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Entity Type | Individual
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Provider Name | TIFFANY MADDOX SPECIALIST
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Gender | Female
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 14497 POTOMAC MILLS RD # 1013
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6807
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Country | US
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Telephone | 571-570-6361
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Fax | 276-530-4153
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Provider Business Mailing Address
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Address Line | 9914 HAGEL CIR
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City | LORTON
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State | VA
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Zip | 22079-4306
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Country | US
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Telephone | 832-537-4426
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Fax | 276-530-4153
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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