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NPI Code Detail

MEDICARE: LILLIAN MARIE TIDLER M.D.

MEDICARE: LILLIAN MARIE TIDLER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician0101057719VA

General Provider Information

NPI Number : 1568432680
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILLIAN MARIE TIDLER M.D.
Provider Business Mailing Address
First Line : 2120 WASHINGTON BLVD
Second Line : FL 3
City : ARLINGTON
State : VA
Zip : 22204
Country : US
Telephone Number : 703-228-5150
Fax Number : 703-228-5157
Provider Business Practice Location Address
First Line : 103 VALLEY CENTER DR
Second Line :
City : STAUNTON
State : VA
Zip : 24401-5080
Country : US
Telephone Number : 540-332-8001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 01/03/2025

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