Individual provider Active NPI

Tiffany J Libby, MD

  • Dermatology Physician
  • Riverside, RI
National Provider Identifier
1912249418
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD16408 Issued in RI
Practice address
375 Wampanoag TRL Ste 401
Riverside, RI 02915-2237
Phone
(401) 444-7959
Fax
(401) 432-6997
NPI assigned
Mar 22, 2013
Last updated
Dec 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD16408 RI Primary

Addresses

Primary practice location

375 Wampanoag TRL Ste 401
Riverside, RI 02915-2237

Mailing address

15 La Salle SQ
Providence, RI 02903-1814
Phone (401) 444-6779

Other practice location 1

65 Village Square Dr Ste 201
South Kingstown, RI 02879-2569
Phone (401) 444-7959

Other practice location 2

400 Bald Hill Rd
Warwick, RI 02886-1617
Phone (401) 444-7954

Other identifiers 1

IdentifierTypeStateIssuer
1912249418MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180829003217 RI Practitioner - Dermatology 6800146689 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians
Brown Dermatology IncGroup PAC ID 3870872773, 28 clinicians

Practice addresses (Care Compare)

375 Wampanoag TRL
Suite 401
Riverside, RI 02915-2237
Phone (401) 444-7959

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-7959

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision62
Removal of skin lesions25
Removal of skin cancer416
Removal of nail tissue1-10
Skin biopsy23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD16408RIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Lifespan Physician Group Inc CurrentSince Jan 1, 2026 Accepting new patients
Brown Dermatology, Inc. Dermatology CurrentSince Aug 16, 2018 Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

110 Elm St
Providence, RI 02903
Phone (401) 443-4992

15 La Salle Sq
Providence, RI 02903

164 Summit Ave
Ste 2D
Providence, RI 02906

593 Eddy St
Providence, RI 02903

593 Eddy St
#10
Providence, RI 02903
Phone (401) 444-7024

375 Wampanoag Trl
Ste 401
Riverside, RI 02915
Phone (401) 632-4455

65 Village Square Dr
Ste 201
South Kingstown, RI 02879
Phone (401) 515-7979

400 Bald Hill Rd
Warwick, RI 02886
Phone (401) 352-0005

17 Wells St
Ste 203
Westerly, RI 02891
Phone (401) 348-0660

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1912249418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LA SALLE SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029031814",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 WAMPANOAG TRL STE 401",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152237",
            "telephone_number": "401-444-7959",
            "fax_number": "401-432-6997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "65 Village Square Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "South Kingstown",
            "state": "RI",
            "postal_code": "028792569",
            "country_code": "US",
            "telephone_number": "401-444-7959",
            "fax_number": "401-515-7910",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Bald Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "RI",
            "postal_code": "028861617",
            "country_code": "US",
            "telephone_number": "401-444-7954",
            "fax_number": "401-738-3857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIBBY",
        "first_name": "TIFFANY",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-22",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "RI",
            "license": "MD16408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912249418",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

Verify at the official NPI Registry.