NPIMap

Organization Active NPI

Tidalhealth Specialty Care, LLC

  • Gastroenterology Physician
  • Berlin, MD
National Provider Identifier
1063225266
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
TIDALHEALTH SPECIALTY CARE, LLC
Practice address
11103 Cathage Rd
Berlin, MD 21811-2114
Phone
(410) 641-2938
NPI assigned
Jan 30, 2025
Last updated
Jul 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
William Pelot
Title
Chief Administrative Officer
Phone
(410) 543-7497

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

11103 Cathage Rd
Berlin, MD 21811-2114

Mailing address

PO Box 825461
Philadelphia, PA 19182-5461
Phone (410) 912-6053

Other names 1

  • TidalHealth Gastroenterology Other name

National Provider Directory

National Provider Directory
Tax ID family
Tidalhealth Specialty Care98 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1063225266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 825461",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191825461",
            "telephone_number": "410-912-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11103 CATHAGE RD",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218112114",
            "telephone_number": "410-641-2938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A",
        "authorized_official_last_name": "PELOT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "410-543-7497"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealth Gastroenterology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TidalHealth Gastroenterology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Berlin, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.