Individual
DR. JONATHAN M TISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
123 SUMMER ST STE 660, WORCESTER, MA 01608-1216
(508) 363-9030
(508) 363-9037
Mailing address
123 SUMMER ST # 695, WORCESTER, MA 01608-1216
(508) 363-9030
(508) 363-9037
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
248639
MA
2084N0600X
Clinical Neurophysiology Physician
Primary
248639
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110092622A
—
MA
Enumeration date
05/09/2008
Last updated
12/21/2020
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