Individual
MR. DAVID EUGENE TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R-PCA
Contact information
Practice address
1 HOSPITAL DR, MASSENA, NY 13662-1056
(315) 769-4200
Mailing address
1 HOSPITAL DR, MASSENA, NY 13662-1056
(315) 769-4200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002506
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02506
PA LISCENCE
NY
05
—
03773219
—
NY
Enumeration date
10/13/2006
Last updated
02/06/2015
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