John S Tidball


Address: 23415 Three Notch Road, 2054 Wildewood Medical Care, California, MD 20619-4018

John S Tidball (NPI# 1760580476, PAC ID# 7214953132) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY PRACTICE.

Physician Overview

Nation Provider ID (NPI) 1760580476
PAC ID by PECOS 7214953132
Professional Enrollment ID I20051020000374
Full Name John S Tidball
Address 23415 Three Notch Road
2054 Wildewood Medical Care
California
MD 20619-4018
Gender M
Credential MD
Medical School UNIVERSITY OF IOWA COLLEGE OF MEDICINE
Graduation Year 1972
Primary Specialty FAMILY PRACTICE
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
210028 MEDSTAR SAINT MARY'S HOSPITAL

Other Locations

Address Phone Organization
23415 Three Notch Road, 2054 Wildewood Medical Care, California, MD 20619-4018
23415 Three Notch Road, California, MD 20619-4018

Organization Information

Office Location

Street Address 23415 THREE NOTCH ROAD
2054 WILDEWOOD MEDICAL CARE
City CALIFORNIA
State MD
Zip 20619-4018

Physicians in the same location

Name Specialty Organization Address
Michelle E Sultage Nurse Practitioner John Scott Tidball, Md, PC 23415 Three Notch Road, 2054 Wildewood Medical Care, California, MD 20619-4018

Physicians in the same zip code

Name Specialty Organization Address
Carmoly T Sanders Optometry Myeyedr Optometry of Maryland LLC 23105 Three Notch Rd, Suite A, California, MD 20619-2417
Nadia K Hopper Physical Therapy Gateau Physical Therapy 23123 Camden Way, California, MD 20619-2447
Meghan J Okoniewski Physical Therapy Gateau Physical Therapy 23123 Camden Way, California, MD 20619-2447
Colleen M Stow Physical Therapy Gateau Physical Therapy 23123 Camden Way, California, MD 20619-2447
Erin Mccarthy Occupational Therapy Personalized Therapy, LLC 22593 Three Notch Rd, California, MD 20619-3054
Susan Barry Qualified Speech Language Pathologist Personalized Therapy, LLC 22593 Three Notch Rd, California, MD 20619-3054
Samantha Yeatman Occupational Therapy Personalized Therapy, LLC 22593 Three Notch Rd, California, MD 20619-3054
Allison Mari Debroisse Physical Therapy Personalized Therapy, LLC 22593 Three Notch Rd, California, MD 20619-3054
Mindi Stavish Qualified Speech Language Pathologist Personalized Therapy, LLC 22593 Three Notch Rd, California, MD 20619-3054
Kelly Barefoot Occupational Therapy Personalized Therapy, LLC 22593 Three Notch Rd, California, MD 20619-3054
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Competitor

Search similar physicians

City CALIFORNIA
Zip Code 20619
Specialty FAMILY PRACTICE
City + Specialty CALIFORNIA + FAMILY PRACTICE

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.

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