Provider Demographics
NPI:1861849580
Name:THOMAS, TIFFANI YVONNE (MD)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:YVONNE
Last Name:THOMAS
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 1:367 S GULPH RD
Mailing Address - Street 2:ATTN IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-306-7733
Mailing Address - Fax:803-716-9456
Practice Address - Street 1:121 AURORA PL STE B
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-5312
Practice Address - Country:US
Practice Address - Phone:803-306-7733
Practice Address - Fax:803-716-9456
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD36325207Q00000X
SC85674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC856746Medicaid