Provider Demographics
NPI:1699816017
Name:BEYDERMAN, LIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIYA
Middle Name:
Last Name:BEYDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N PINE ST UNIT 4403
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2655
Mailing Address - Country:US
Mailing Address - Phone:443-416-5539
Mailing Address - Fax:
Practice Address - Street 1:6115 PARK SOUTH DR STE 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0104
Practice Address - Country:US
Practice Address - Phone:704-981-6800
Practice Address - Fax:704-944-8389
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA087835002080P0008X
NC2017-019712084N0600X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty