Individual
DR. BRITTON EDGETT TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., B.SC.PHM.
Contact information
Practice address
36 NATURE COVE CT, AMHERST, NY 14221-1978
(716) 319-8113
Mailing address
180 VINE STREET SOUTH, SUITE 202, ST. CATHARINES, ONTARIO L2R 7-P3
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
003851
NY
208800000X
Urology Physician
0116021688
VA
208800000X
Urology Physician
Primary
271542
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1916947
IHA
NY
01
—
29695201
UNIVERA
NY
05
—
3383479
—
NY
01
—
533379001
BLUE CROSS
NY
01
—
652569
WELLCARE
NY
Enumeration date
08/14/2010
Last updated
04/08/2025
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