MEDICARE: MRS. TIFANI DAVIS GILLIAM 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	2085R0202X	Diagnostic Radiology Physician	MD035810	DC
2	2085R0202X	Diagnostic Radiology Physician	D66654	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952320459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFANI DAVIS GILLIAM MD

Provider Business Mailing Address
First Line	:	900 23RD ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20037-2342
Country	:	US
Telephone Number	:	202-715-5190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 MEDICAL PARK DR
Second Line	:	STE 3
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4054
Country	:	US
Telephone Number	:	301-681-3003
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/20/2011

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