MEDICARE: DR. JOHN MARTIN TIDD PSY.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
1	103TC0700X	Clinical Psychologist	4311	OH
2	103TC0700X	Clinical Psychologist	694	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780808741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MARTIN TIDD PSY.D.

Provider Business Mailing Address
First Line	:	11497 SPRINGFIELD PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3551
Country	:	US
Telephone Number	:	513-772-9300
Fax Number	:	513-772-9302

Provider Business Practice Location Address
First Line	:	11497 SPRINGFIELD PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3551
Country	:	US
Telephone Number	:	513-772-9300
Fax Number	:	513-772-9302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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