Provider Demographics
NPI:1598491623
Name:BAYNE, TIFFANY MELISSA (CPT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MELISSA
Last Name:BAYNE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MELISSA
Other - Last Name:BAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPT
Mailing Address - Street 1:6815 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-5302
Mailing Address - Country:US
Mailing Address - Phone:610-335-6724
Mailing Address - Fax:267-500-9889
Practice Address - Street 1:6815 CLOVER LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-5302
Practice Address - Country:US
Practice Address - Phone:610-335-6724
Practice Address - Fax:267-500-9889
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAC4T2H2M6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1913919082Medicaid