JOHN SCOTT TIDBALL MD PC NPI 1770659609

NPI Information

  • NPI: 1770659609
  • Provider Name: JOHN SCOTT TIDBALL, MD, PC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: WILDEWOOD MEDICAL CARE
  • Address: 23415 THREE NOTCH RD
    STE 2054 WILDEWOOD CTR
    CALIFORNIA, MD
    ZIP 20619
  • Phone: (301) 737-7833

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NPI Details

JOHN SCOTT TIDBALL, MD, PC is a family medicine in California, MD. 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. JOHN SCOTT TIDBALL, MD, PC NPI is 1770659609. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Wildewood Medical Care.

The provider's business location address is:

23415 THREE NOTCH RD
STE 2054 WILDEWOOD CTR
CALIFORNIA, MD
ZIP 20619-017
Phone: (301) 737-7833
Fax: (301) 737-4865

The provider's authorized official is John Scott Tidball .
The authorized official title is Owner and has the following contact phone number (301) 737-7833.

The enumeration date for this NPI number is 11/24/2006 and was last updated on 4/4/2011.

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 MedicineD52196MARYLANDYes

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
1G61586MEDICARE UPINMARYLAND
2138950500MEDICAIDMARYLAND

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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