Provider Demographics
NPI:1447435227
Name:MIDDLETON, TIFFANI MARGUERITE (MD)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:MARGUERITE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 MERRITT BLVD
Mailing Address - Street 2:STE 16
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-2132
Mailing Address - Country:US
Mailing Address - Phone:410-650-2191
Mailing Address - Fax:410-288-4567
Practice Address - Street 1:1576 MERRITT BLVD
Practice Address - Street 2:STE 16
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-2132
Practice Address - Country:US
Practice Address - Phone:410-650-2191
Practice Address - Fax:410-288-4567
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01863207VX0000X, 174400000X
MDD77232207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC151MKOtherBCBS
NC5910673Medicaid
NC151MKOtherBCBS