Provider Demographics
NPI:1568673994
Name:PICKUP, TIFFANY L (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:PICKUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7794 5 MILE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-2368
Mailing Address - Country:US
Mailing Address - Phone:513-231-1575
Mailing Address - Fax:513-232-8490
Practice Address - Street 1:7794 5 MILE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2368
Practice Address - Country:US
Practice Address - Phone:513-231-1575
Practice Address - Fax:513-232-8490
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35095319207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000674141OtherANTHEM
OH000000674141OtherANTHEM