Organization
JOHN SCOTT TIDBALL, MD, PC
Active
Other names
Wildewood Medical Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN SCOTT TIDBALL MD (OWNER)
(301) 737-7833
Entity
Organization
Contact information
Practice address
23415 THREE NOTCH RD, STE 2054 WILDEWOOD CTR, CALIFORNIA, MD 20619-4017
(301) 737-7833
(301) 737-4865
Mailing address
23415 THREE NOTCH RD, STE 2054 WILDEWOOD CTR, CALIFORNIA, MD 20619-4017
(301) 737-7833
(301) 737-4865
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D52196
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
138950500
—
MD
Enumeration date
11/24/2006
Last updated
04/04/2011
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