Provider Demographics
NPI:1790051886
Name:TIDERINGTON, EVAN T (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:T
Last Name:TIDERINGTON
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 1:191 BILTMORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4109
Mailing Address - Country:US
Mailing Address - Phone:828-254-0881
Mailing Address - Fax:828-254-1614
Practice Address - Street 1:191 BILTMORE AVENUE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4109
Practice Address - Country:US
Practice Address - Phone:828-254-0881
Practice Address - Fax:828-254-1614
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301115753207RG0100X
390200000X
NC2021-02139207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program