Provider Demographics
NPI:1023316726
Name:BENDER, TIM DAVID (MS, RD, LD)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:DAVID
Last Name:BENDER
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LOST VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3331
Mailing Address - Country:US
Mailing Address - Phone:304-638-7984
Mailing Address - Fax:
Practice Address - Street 1:10 LOST VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-3331
Practice Address - Country:US
Practice Address - Phone:304-638-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV720133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered