Basic Information
| Provider Information | |||||||||
| NPI: | 1710193982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AVERY | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | PEREZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PEREZ | ||||||||
| OtherFirstName: | TIFFANY | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
| FaxNumber: | 3367163202 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 CHESTNUT STREET | ||||||||
| Address2: | SUITE 320A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159558874 | ||||||||
| FaxNumber: | 2159552340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD440953 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT182213 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | MD440953 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.