# JOHN SCOTT TIDBALL, MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wildewood Medical Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770659609
- **Authorized official:** DR. JOHN SCOTT TIDBALL MD (OWNER)
- **Authorized official phone:** (301) 737-7833

## Contact information

- **Practice address:** 23415 THREE NOTCH RD, STE 2054 WILDEWOOD CTR, CALIFORNIA, MD 20619-4017
- **Practice address phone:** (301) 737-7833
- **Practice address fax:** (301) 737-4865
- **Mailing address:** 23415 THREE NOTCH RD, STE 2054 WILDEWOOD CTR, CALIFORNIA, MD 20619-4017
- **Mailing address phone:** (301) 737-7833
- **Mailing address fax:** (301) 737-4865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D52196 | MD | Yes |

## Other

- **Enumeration date:** 11/24/2006
- **Last updated:** 04/04/2011