Provider Demographics
NPI:1083935357
Name:TILDEN, SAMUEL GREY (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GREY
Last Name:TILDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N JUSTICE
Mailing Address - Street 2:BOX 16
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3410
Mailing Address - Country:US
Mailing Address - Phone:828-684-8385
Mailing Address - Fax:828-684-7654
Practice Address - Street 1:1824 PISGAH DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791
Practice Address - Country:US
Practice Address - Phone:828-694-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC164560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine