TIDALHEALTH PHYSICIAN NETWORK INC. NPI 1205649514

NPI Information

  • NPI: 1205649514
  • Provider Name: TIDALHEALTH PHYSICIAN NETWORK, INC.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • :
  • CLIA Number: 08D2087944
  • Address: 30549 SUSSEX HWY
    LAUREL, DE
    ZIP 19956
  • Phone: (302) 297-2579

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NPI Details

TIDALHEALTH PHYSICIAN NETWORK, INC. is a family medicine in Laurel, DE. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. TIDALHEALTH PHYSICIAN NETWORK, INC. NPI is 1205649514. The provider is registered as an organization entity type and is a single specialty group.
The provider .

The provider's business location address is:

30549 SUSSEX HWY
LAUREL, DE
ZIP 19956-891
Phone: (302) 297-2579

The provider's authorized official is William Pelot .
The authorized official title is Chief Administrator Officer and has the following contact phone number (410) 543-7497.

The CLIA number assigned to this NPI record is 08D2087944 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/30/2025 and was last updated on 7/22/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 11/21/2025

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