DR. JONATHAN M TISDELL (NPI# 1528235447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528235447 |
| Entity Type | Individual |
| Full Name | DR. JONATHAN M TISDELL |
| Credential | MD |
| Practice Address |
123 Summer St 695 Worcester MA 01608-1216 |
| Mailing Address |
123 Summer St # 695 Worcester MA 01608-1216 |
| Practice Telephone | 5083639030 |
| Practice Fax Number | 5083639037 |
| Mailing Telephone | 5083639030 |
| Mailing Fax Number | 5083639037 |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2020-10-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
248639 | MA | Allopathic & Osteopathic Physicians |
| Y | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
248639 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110092622A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 123 Summer St Ste 660, Worcester, MA 016081216 | 5083639030 | 5083639037 |
| Street Address |
123 SUMMER ST 695 |
| City | WORCESTER |
| State | MA |
| Zip Code | 01608-1216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265434229 | Thom A. Tarquinio | Orthopaedic Surgery | 123 Summer St, Suite 320, Worcester, MA 01608-1216 | 2005-06-02 |
| 1396352092 | Arushi Sharma | Internal Medicine | 123 Summer St, Worcester, MA 01608-1216 | 2020-09-26 |
| 1134733280 | Freda Agyemang | Nurse Practitioner | 123 Summer St, Worcester, MA 01608-1216 | 2020-09-06 |
| 1316559305 | Bijay Khanal | Student in an Organized Health Care Education/Training Program | 123 Summer St, Worcester, MA 01608-1216 | 2020-08-20 |
| 1497367395 | Hajrah Ahsan | Student in an Organized Health Care Education/Training Program | 123 Summer St, Worcester, MA 01608-1216 | 2020-08-20 |
| 1205448487 | Sajjadh Mohamed Jawahar Ali | Internal Medicine | 123 Summer St, Worcester, MA 01608-1216 | 2020-08-19 |
| 1639781909 | Kamal Pokhrel | Student in an Organized Health Care Education/Training Program | 123 Summer St, Worcester, MA 01608-1216 | 2020-08-18 |
| 1366054637 | Regina Devi Shrestha | Student in an Organized Health Care Education/Training Program | 123 Summer St, Worcester, MA 01608-1216 | 2020-08-18 |
| 1912519489 | Mithun George Jacob | Internal Medicine | 123 Summer St, Worcester, MA 01608-1216 | 2020-08-17 |
| 1194336800 | Anil Phuyal | Internal Medicine | 123 Summer St, Worcester, MA 01608-1216 | 2020-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033721733 | Rebecca Smith Morgan | Physical Therapist | Easter Seals Massachusetts, 484 Main St, Worcester, MA 01608 | 2020-08-24 |
| 1083244057 | Marc Labb | Counselor | 25 Union St 3rd Floor, Worcester, MA 01608 | 2020-01-18 |
| 1154974145 | Shanil Shah | Student in an Organized Health Care Education/Training Program | St Vincent Hospital, Department of Internal Medicine, 123 Summer Street, Worcester, MA 01608 | 2019-07-19 |
| 1194377069 | Varun Kommalapati | Student in an Organized Health Care Education/Training Program | St Vincent Hospital, 123 Summer Street, Worcester, MA 01608 | 2019-07-11 |
| 1992361182 | Jenna Recko | Physical Therapy Assistant | Easter Seals of Massachusetts, 484 Main St, Worcester, MA 01608 | 2019-05-14 |
| 1619452646 | Kara Thompson | Registered Nurse | 100 Martin Luther King Jr Blvd, Worcester, MA 01608 | 2018-09-25 |
| 1427555325 | Baran Umut Vardar | Student in an Organized Health Care Education/Training Program | 123 Summer Street, Saint Vincent Hospital Radiology Dep, Worcester, MA 01608 | 2018-04-09 |
| 1609380765 | Mary Elizabeth O'donnell | Occupational Therapist | Easter Seals Ma, 484 Main Street, Worcester, MA 01608 | 2017-11-28 |
| 1093227316 | Oasis Home Care, LLC | Home Health | 340 Main St Ste 803, Worcester, MA 01608 | 2017-10-26 |
| 1912437500 | Peter A Rondon | Social Worker | 11 Sycamore Street, Worcester, MA 01608 | 2017-06-15 |
| Find all providers in zip 01608 | ||||
| Taxonomy Code | 2084N0600X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Clinical Neurophysiology |
| Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083168256 | Shreyans Shah | Psychiatry & Neurology | 330 Brookline Ave, Shapiro 8 Tcc, Boston, MA 02215-5400 | 2016-08-05 |
| 1255642286 | Gina Deck | Psychiatry & Neurology | Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 | 2010-06-24 |
| 1164743092 | Neurology of Central Massachusetts, PC | Psychiatry & Neurology | 50 Memorial Dr, Suite 211, Leominster, MA 01453-2238 | 2010-06-15 |
| 1932339025 | Swapna Lakshmi Putta | Psychiatry & Neurology | 55 Fogg Road, Bwh Department of Neurology, Emerson 150, South Weumouth, MA 02190 | 2009-07-23 |
| 1275723413 | George A. Gonzalez, M.d., P.C. | Psychiatry & Neurology | 131 Old Road To 9 Acre Cor, Suite 660, Concord, MA 01742-4181 | 2007-07-25 |
| 1427255538 | Green Mountain Neurology, Inc | Psychiatry & Neurology | 777 North St, Suite 205, Pittsfield, MA 01201-4147 | 2007-07-02 |
| 1649227356 | Kaarkuzhali Babu Krishnamurthy | Psychiatry & Neurology | 736 Cambridge St, Boston, MA 02135-2907 | 2006-05-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.