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.
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 |
Claim Control Number (CCN) | Legal Business Name |
---|---|
210028 | MEDSTAR SAINT MARY'S HOSPITAL |
Address | Phone | Organization |
---|---|---|
23415 Three Notch Road, 2054 Wildewood Medical Care, California, MD 20619-4018 | ||
23415 Three Notch Road, California, MD 20619-4018 |
Street Address |
23415 THREE NOTCH ROAD 2054 WILDEWOOD MEDICAL CARE |
City | CALIFORNIA |
State | MD |
Zip | 20619-4018 |
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 |
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 |
Find all physicians in zip 20619 |
City | CALIFORNIA |
Zip Code | 20619 |
Specialty | FAMILY PRACTICE |
City + Specialty | CALIFORNIA + FAMILY PRACTICE |
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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.