Individual
DR. CHUCKIA NICOLE BROWN-TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11110 MEDICAL CAMPUS RD STE 143, HAGERSTOWN, MD 21742-6755
(301) 714-4175
(301) 714-4183
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0063718
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409370400
—
MD
Enumeration date
10/26/2005
Last updated
01/20/2020
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