Individual
PHILIP A TISDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 HAMPTON RD, UNIT 208, EXETER, NH 03833-4849
(603) 778-8522
(603) 778-1602
Mailing address
PO BOX 100519, ATLANTA, GA 30384-0519
(888) 208-6228
(603) 778-1602
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
57504
MA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
7703
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105363Y0HN01
BCBS
NH
05
—
30002058
—
NH
05
—
3021904
—
MA
01
—
57504
MEDICAL LICENSURE
MA
01
—
7703
MEDICAL LICENSURE
NH
01
—
R01137
BCBS
MA
Enumeration date
05/23/2005
Last updated
06/03/2008
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