MR. DAVID EUGENE TISDALE R-PCA NPI 1396835112

NPI Information

  • NPI: 1396835112
  • Provider Name: MR. DAVID EUGENE TISDALE, R-PCA
  • Classification: Physician Assistant - 363A00000X
  • Entity Type: Individual
  • Address: 1 HOSPITAL DR
    MASSENA, NY
    ZIP 13662
  • Phone: (315) 769-4200

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NPI Details

MR. David Eugene Tisdale, R-PCA is a physician assistant in Massena, NY. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. MR. David Eugene Tisdale, R-PCA NPI is 1396835112. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1 HOSPITAL DR
MASSENA, NY
ZIP 13662-056
Phone: (315) 769-4200

The enumeration date for this NPI number is 10/13/2006 and was last updated on 2/6/2015.

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
1363A00000XPhysician Assistant002506NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1R85715MEDICARE UPINNEW YORK
203773219MEDICAIDNEW YORK
3J400141537MEDICARE PINNEW YORK
402506OTHERNEW YORKPA LISCENCE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

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

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