Organization
TIDA HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDA KONCHOU CRNP (CEO)
(443) 570-7610
Entity
Organization
Contact information
Practice address
2209 MONTAUK DR, CROFTON, MD 21114-3245
(443) 570-7610
Mailing address
2209 MONTAUK DR, CROFTON, MD 21114-3245
(443) 570-7610
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
04/19/2022
Last updated
06/02/2022
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