Provider Demographics
NPI:1386424190
Name:HIDER, TIMOTHY (PEER SUPPORT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HIDER
Suffix:
Gender:M
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 U ST NE APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1448
Mailing Address - Country:US
Mailing Address - Phone:240-935-6010
Mailing Address - Fax:
Practice Address - Street 1:1320 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6912
Practice Address - Country:US
Practice Address - Phone:202-610-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty