Provider Demographics
NPI:1720026438
Name:VANDERHEYDEN, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:VANDERHEYDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:VANDERHEYDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1208 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4254
Mailing Address - Country:US
Mailing Address - Phone:251-626-5377
Mailing Address - Fax:
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-626-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90522207P00000X
AL27874207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A905220Medicaid
AL51539305OtherBCBS OF ALABAMA
CA00A905220Medicaid
AL051539305Medicare PIN
CAWA90522BMedicare ID - Type Unspecified