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General NPI Number Information
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NPI Number | 1215001045
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Entity Type | Organization
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Legal Business Name | BERNARD A TISDALE MD PC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 26079 LEE HIGHWAY
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City | ABINGDON
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State | VA
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Zip | 24211
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Country | US
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Telephone | 276-739-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1020A BOAL AVE
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City | BOALSBURG
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State | PA
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Zip | 16827-1509
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Country | US
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Telephone | 814-237-8627
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Fax | 814-238-0083
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Authorized Official
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Title or Position | OWNER
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Name | BERNARD T TISDALE
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Credential | MD
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Telephone | 804-254-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State | VA
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