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
Fax: (301) 737-4865
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760580476 NPPES
Maryland MEDICAID 1389505000

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