John Scott Tidball, Md, PC

NPI #1770659609 in California, Maryland

Provider Information

NPI Number: 1770659609
Entity Type: Organization
Organization Name: John Scott Tidball, Md, PC
Primary Specialty: Family Medicine
Enumeration Date: Nov 24, 2006
Last Updated: Apr 4, 2011

Practice Location

Address: 23415 THREE NOTCH RD
Address 2: STE 2054 WILDEWOOD CTR
City: California
State: Maryland
ZIP Code: 20619-4017
Phone: (301) 737-7833

Authorized Official

Name: DR. JOHN SCOTT TIDBALL, MD
Title: OWNER
Phone: (301) 737-7833

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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