Individual
DOUGLAS TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER, BURLINGTON, MA 01805-3648
(781) 744-8400
(781) 744-5245
Mailing address
PO BOX 808, NASHUA, NH 03061-0808
(603) 578-5054
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
13131
NH
207RH0003X
Hematology & Oncology Physician
Primary
153488
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3074335
—
NH
Enumeration date
11/22/2005
Last updated
08/13/2020
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