Provider Demographics
NPI:1922155811
Name:VAN DER HEIJDEN, YURI F (MD)
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:F
Last Name:VAN DER HEIJDEN
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 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-322-2035
Mailing Address - Fax:615-343-6160
Practice Address - Street 1:1161 21ST AVE S
Practice Address - Street 2:A2200 MEDICAL CENTER NORTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2582
Practice Address - Country:US
Practice Address - Phone:615-322-2035
Practice Address - Fax:615-343-6160
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43209207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506842Medicaid
P00710546OtherRAILROAD MEDICARE
TN0009170178OtherAETNA
7100051280OtherKENTUCKY MEDICAID
TN4193026OtherBCBST
P00710546OtherRAILROAD MEDICARE