Healthcare Provider Details

I. General information

NPI: 1861361644
Provider Name (Legal Business Name): TIDALHEALTH SPECIALTY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 WOODBROOKE DRIVE SUITE B
SALISBURY MD
21804-8507
US

IV. Provider business mailing address

PO BOX 824561
PHILADELPHIA PA
19182-4561
US

V. Phone/Fax

Practice location:
  • Phone: 410-912-6875
  • Fax: 410-912-6876
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: INSURANCE CREDENTIALING MANAGER
Credential:
Phone: 410-912-6989