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General NPI Number Information
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NPI Number | 1568434405
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Entity Type | Individual
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Provider Name | TIFFANY ELYSE ANGELO D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2006
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 8901 ROCKVILLE PIKE WALTER REED NATIONAL MILITARY MEDICAL CENTER
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City | BETHESDA
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State | MD
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Zip | 20889-6110
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Country | US
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Telephone | 617-732-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 10101 DICKENS AVE
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City | BETHESDA
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State | MD
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Zip | 20814-2109
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Country | US
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Telephone | 631-759-0328
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | H-75910
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License Number State | MD
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