MEDICARE: DR. LOUISA MAE TIFT M.D.

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	207N00000X	Dermatology Physician	242339	NY

General Provider Information

NPI Number	:	1972645307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUISA MAE TIFT M.D.

Provider Business Mailing Address
First Line	:	3620 E TREMONT AVE
Second Line	:	2ND FLOOR
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-792-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-792-4700
Fax Number	:	718-792-1255

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	06/10/2021

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