Basic Information
| Provider Information | |||||||||
| NPI: | 1699734863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDERKWAAK | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16948 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288160948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286708403 | ||||||||
| FaxNumber: | 8286708404 | ||||||||
| Practice Location | |||||||||
| Address1: | 609 ASHEVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | SYLVA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287792747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285867697 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2000-00648 | NC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0201X | 200000648 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 89126HC | 05 | NC | MEDICAID | 126HC | 01 | NC | BLUE CROSS | OTHER |