# TIDALHEALTH SPECIALTY CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588544134
- **Authorized official:** WILLIAM PELOT (CHIEF ADMINISTRATIVE OFFICER)
- **Authorized official phone:** (410) 546-7497

## Contact information

- **Practice address:** 11107 CATHAGE RD UNIT 103, BERLIN, MD 21811-2155
- **Practice address phone:** (410) 912-5674
- **Mailing address:** PO BOX 825461, PHILADELPHIA, PA 19182-5461

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/04/2025
- **Last updated:** 09/04/2025