MEDICARE: TIFFANY MADSEN OHTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2016-00856	NC

General Provider Information

NPI Number	:	1144398413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MADSEN OHTA MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6488 WEDDINGTON MONROE RD
Second Line	:
City	:	WESLEY CHAPEL
State	:	NC
Zip	:	28104-7948
Country	:	US
Telephone Number	:	704-384-8460
Fax Number	:	704-384-1018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	01/27/2025

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