JOHN SCOTT TIDBALL (NPI# 1760580476) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760580476 |
| Entity Type | Individual |
| Full Name | JOHN SCOTT TIDBALL |
| Credential | M.D. |
| Practice Address |
23415 Three Notch Rd Suite 2054 Wildewood Center California MD 20619-4017 |
| Mailing Address |
23415 Three Notch Rd Suite 2054 California MD 20619-4017 |
| Practice Telephone | 3017377833 |
| Practice Fax Number | 3017374865 |
| Mailing Telephone | 3017377833 |
| Mailing Fax Number | 3017374865 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-04-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | D52196 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 1389505000 | 05 |
| Street Address |
23415 THREE NOTCH RD SUITE 2054 WILDEWOOD CENTER |
| City | CALIFORNIA |
| State | MD |
| Zip Code | 20619-4017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447235171 | Mia Bartuska Finkelston | Specialist | 23415 Three Notch Rd, Suite 2052, Wildewood Center, California, MD 20619-4017 | 2005-12-15 |
| 1265971477 | Visionworks Inc. | Eyewear Supplier (Equipment, not the service) | 23415 Three Notch Rd, Suite 1101, California, MD 20619-4017 | 2017-02-21 |
| 1942641477 | Dylan Schneider Dds Ms LLC | Dentist | 23415 Three Notch Rd, Suite 2003, California, MD 20619-4017 | 2013-07-12 |
| 1225348303 | Back At Your Best Chiropractic & Physical Therapy | Chiropractor | 23415 Three Notch Rd, Suite 2045, California, MD 20619-4017 | 2010-10-07 |
| 1104043157 | Michael Jeffrey Kuhn | Dentist | 23415 Three Notch Rd, Suite #2003, California, MD 20619-4017 | 2007-04-19 |
| 1518184126 | Michael J Kuhn Dds PC | Dentist | 23415 Three Notch Rd, #2003, California, MD 20619-4017 | 2007-04-18 |
| 1770659609 | John Scott Tidball, Md, PC | Family Medicine | 23415 Three Notch Rd, Ste 2054 Wildewood Ctr, California, MD 20619-4017 | 2006-11-24 |
| 1841379781 | Nichole Lynn Pelletier | Nurse Practitioner | 23415 Three Notch Rd, Suite 2054 Wildwood Center, California, MD 20619-4017 | 2006-11-02 |
| 1902830656 | Carl H Ling | Dermatology | 23415 Three Notch Rd, Suite 2052, California, MD 20619-4017 | 2006-07-10 |
| 1407883051 | Annie Verghese | Dermatology | 23415 Three Notch Rd, Suite 2052, California, MD 20619-4017 | 2006-06-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851932412 | Ebony Thomas | Technician | 23560 Fdr Blvd, #402, California, MD 20619 | 2019-10-04 |
| 1538723374 | Pyramid Walden LLC | Counselor | 44871 St. Andrews Church Rd., California, MD 20619 | 2019-04-26 |
| 1902378714 | Pyramid Walden, LLC | Clinic/Center | 44863 St. Andrews Church Rd., California, MD 20619 | 2018-12-19 |
| 1073084885 | Pyramid Walden, LLC | Substance Abuse Rehabilitation Facility | 44863 St. Andrew's Church Rd, California, MD 20619 | 2018-12-06 |
| 1972099489 | Leslie Ann Gilbert | Audiologist | 23077 Three Notch Rd Ste 101, California, MD 20619 | 2018-07-09 |
| 1538575261 | Eric Ndoumbe Ndimasa | Pharmacist | 22565 Three Notch Road, California, MD 20619 | 2014-07-02 |
| 1790121861 | Oluwagbolahan Oladipo Lagoke | Pharmacist | 45482 Miramar Way, Walmart, California, MD 20619 | 2013-05-16 |
| 1831437128 | Dylan Schneider | Dentist | 23415 Three Notch Road, Suite 2003, California, MD 20619 | 2013-01-22 |
| 1659603322 | Pyramid Walden, LLC | Counselor | 44867 St. Andrews Church Road, California, MD 20619 | 2010-02-05 |
| 1376742270 | Platinum Eyes | Eyewear Supplier (Equipment, not the service) | 45315 Alton Ln, Suite 16038, California, MD 20619 | 2007-07-12 |
| Find all providers in zip 20619 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801184759 | Lakshmi Lavanya Marella | Family Medicine | 22590 Shady Ct Fl 1, California, MD 20619-5009 | 2011-07-13 |
| 1609005321 | Mitzi Doreen Baladiang Balbona | Family Medicine | Us Hwy 101s, California, CA 93960 | 2009-07-02 |
| 1215114749 | Shah Associates Md LLC | Family Medicine | 23415 Three Notch Rd # Store50, California, MD 20619-4017 | 2008-01-28 |
| 1083897862 | Jefferson City Medical Group, PC | Family Medicine | 606 E Buchanan St, California, MO 65018-1910 | 2007-12-14 |
| 1245264563 | Narasimham Iswara | Family Medicine | 22576 Macarthur Blvd, California, MD 20619-3086 | 2006-07-10 |
| 1336104660 | Min H Park | Family Medicine | 217 Wood St, California, PA 15419 | 2006-04-19 |
| 1730151143 | Capital Region Medical Center | Family Medicine | 704 Buchanan Hwy Sw, California, MO 65018 | 2006-02-02 |
| 1770574352 | Allison Francis Verenna | Family Medicine | 415 3rd St, California, PA 15419-1102 | 2005-11-02 |
| 1851382535 | Marvin Mcgowan | Family Medicine | 1152 Wood St, California, PA 15419-1260 | 2005-11-02 |
| 1952393530 | Janet E Akremi | Family Medicine | 800 W Buchanan St, California, MO 65018-1270 | 2005-08-18 |
| Find all providers in CALIFORNIA | ||||
| City | CALIFORNIA |
| Zip Code | 20619 |
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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.