Healthcare Provider Details

I. General information

NPI: 1851213854
Provider Name (Legal Business Name): TIDALHEALTH SPECIALTY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11107 CATHAGE RD UNIT 104
BERLIN MD
21811-2155
US

IV. Provider business mailing address

PO BOX 825461
PHILADELPHIA PA
19182-5461
US

V. Phone/Fax

Practice location:
  • Phone: 410-641-0948
  • Fax: 410-641-9516
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SLOAN TRAMMELL
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 410-912-6989