Individual
MARIE THERESE TIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
635 N WASHINGTON HWY, ASHLAND, VA 23005-1317
(804) 798-9208
(804) 798-8108
Mailing address
635 N WASHINGTON HIGHWAY, ASHLAND, VA 23005-1317
(804) 798-9208
(804) 798-8108
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101035312
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0574
GROUP PTAN
VA
Enumeration date
04/26/2006
Last updated
09/26/2013
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