Provider Demographics
NPI:1952608051
Name:BAERWALD, NEILAND (DPH)
Entity Type:Individual
Prefix:MR
First Name:NEILAND
Middle Name:
Last Name:BAERWALD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 BLACK BEAR RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-8084
Mailing Address - Country:US
Mailing Address - Phone:865-908-7911
Mailing Address - Fax:
Practice Address - Street 1:220 WEARS VALLEY RD
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-4215
Practice Address - Country:US
Practice Address - Phone:865-428-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9325183500000X
ND3501183500000X
IN26091728A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist