Individual
MR. JASON TIVADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2905 MITCHELLVILLE RD STE 204, BOWIE, MD 20716-3961
(301) 701-6965
Mailing address
9810 COTTRELL TER, SILVER SPRING, MD 20903-1917
(240) 304-0043
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R212283
MD
Other
Enumeration date
05/26/2025
Last updated
05/26/2025
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