Individual
BERNARD ALVAN TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1109 W MARSHALL ST, RICHMOND, VA 23220-3835
(804) 257-7337
(804) 359-6898
Mailing address
1109 W MARSHALL ST, RICHMOND, VA 23220-3835
(804) 257-7337
(804) 359-6898
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
0101040236
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5866740
—
VA
Enumeration date
11/10/2005
Last updated
07/08/2007
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