Provider Demographics
NPI:1316993736
Name:TIERNEY, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:TIERNEY
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-971-7099
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:10710 SIKES PL STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8194
Practice Address - Country:US
Practice Address - Phone:704-485-1012
Practice Address - Fax:704-248-5120
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2025-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2000-00326207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-1259XMedicaid
SCN00326Medicaid
SCN00326Medicaid
NC89-1259XMedicaid