Tidball, John Scott
Tidball, John Scott is an individual health care provider with primary practice located at 23415 Three Notch Rd Suite 2054 Wildewood Center, California MD 20619-4017. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Tidball, John Scott can be contacted via phone (301) 737-7833.Contact Information
Primary practice address
23415 Three Notch Rd Suite 2054 Wildewood Center
California MD 20619-4017
Phone: (301) 737-7833
Fax: (301) 737-4865
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | D52196 | Maryland |
Profile Details
| NPI number | 1760580476 |
|---|---|
| LBN Legal business name | Tidball, John Scott |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 20th, 2006 |
| Last updated | Apr 18th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760580476 | NPPES |
| Maryland | MEDICAID | 1389505000 |
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