Individual
MRS. TIFANI DAVIS GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2121 MEDICAL PARK DR, STE 3, SILVER SPRING, MD 20902-4054
(301) 681-3003
Mailing address
900 23RD ST NW, WASHINGTON, DC 20037-2342
(202) 715-5190
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
D66654
MD
2085R0202X
Diagnostic Radiology Physician
Primary
MD035810
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410243601
—
MD
Enumeration date
07/18/2006
Last updated
01/20/2011
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