Basic Information
| Provider Information | |||||||||
| NPI: | 1790051886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIDERINGTON | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 BILTMORE AVENUE | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282540881 | ||||||||
| FaxNumber: | 8284125453 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 BILTMORE AVENUE | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282540881 | ||||||||
| FaxNumber: | 8284125453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2012 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 4301115753 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | 2021-02139 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.