Provider Demographics
NPI:1104020817
Name:OWENS, TIFFANY S (MD)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:S
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:S
Other - Last Name:OWENS-PEGUES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:585 MAIN ST STE 145
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4354
Mailing Address - Country:US
Mailing Address - Phone:301-298-8267
Mailing Address - Fax:301-517-9386
Practice Address - Street 1:3735 GLENLAKE DR STE 250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6866
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:704-626-3237
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-02715207L00000X
MD21797207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD033938500Medicaid
MD186256YUWMedicare PIN