21D2023460 CLIA NUMBER - TIDALHEALTH GASTROENTEROLOGY

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Laboratory Demographics

CLIA Number: 21D2023460

Facility Name: TIDALHEALTH GASTROENTEROLOGY

Facility Address:
560 RIVERSIDE DRIVE SUITE A, 206
SALISBURY, MD
ZIP 21801
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Facility Phone Number: 410 912-5640

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013532969

Taxonomy: 207RG0100X - Internal Medicine
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.

CLIA Record

Field Name	Field Value
CLIA Number	21D2023460
LAB Type	Physician Office
Facility Name	TIDALHEALTH GASTROENTEROLOGY
Street	560 RIVERSIDE DRIVE SUITE A, 206
City	SALISBURY
State	MD
ZIP	21801
Phone	410 912-5640
CertificateType	4
CertificateEffectiveDate	4/25/2023
CertificateExpirationDate	4/24/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024