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General NPI Number Information
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NPI Number | 1144049412
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Entity Type | Organization
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Legal Business Name | TIDALHEALTH PRIMARY CARE, LLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 1639 WOODBROOKE DR
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City | SALISBURY
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State | MD
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Zip | 21804-8502
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Country | US
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Telephone | 410-912-5785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 825474
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5474
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Country | US
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Telephone | 410-912-6989
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Fax | 410-912-4972
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Authorized Official
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Title or Position | CHIEF ADMINISTRATOR OFFICER
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Name | WILLIAM PELOT
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Credential |
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Telephone | 410-543-7497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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