Healthcare Provider Details

I. General information

NPI: 1790051886
Provider Name (Legal Business Name): EVAN T TIDERINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 SWEETEN CREEK ROAD
ASHEVILLE NC
28803-1527
US

IV. Provider business mailing address

291 SWEETEN CREEK RD
ASHEVILLE NC
28803-1527
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-0881
  • Fax: 828-254-1614
Mailing address:
  • Phone: 828-254-0881
  • Fax: 828-254-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2021-02139
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301115753
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: