Provider Demographics
NPI:1104869700
Name:INGLIS, TIFFANY ED (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ED
Last Name:INGLIS
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 1:1 HEALTHY PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7067
Mailing Address - Country:US
Mailing Address - Phone:220-564-1920
Mailing Address - Fax:220-564-1921
Practice Address - Street 1:1 HEALTHY PL
Practice Address - Street 2:SUITE 201
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7067
Practice Address - Country:US
Practice Address - Phone:220-564-1920
Practice Address - Fax:220-564-1921
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084533207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2867223Medicaid
OH2867223Medicaid
OH4180704Medicare PIN