Provider Demographics
NPI:1245275072
Name:HEIDER, TIMOTHY RYAN (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RYAN
Last Name:HEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T
Other - Middle Name:RYAN
Other - Last Name:HEIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:106 ALEXANDER BANK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9624
Mailing Address - Country:US
Mailing Address - Phone:704-660-4584
Mailing Address - Fax:704-660-4967
Practice Address - Street 1:106 ALEXANDER BANK DR STE 300
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9624
Practice Address - Country:US
Practice Address - Phone:704-660-4584
Practice Address - Fax:704-660-4967
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20001489208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery