Tidalhealth Primary Care, LLC
Organization Active NPI Family Medicine Physician · Salisbury, MD
NPI 1104453208 · NPPES record last updated Jul 22, 2025
Key facts
- NPI
- 1104453208
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- TIDALHEALTH PRIMARY CARE, LLC
- Practice address
- 100 E Carroll St
Salisbury, MD 21801-5422 - Phone
- (410) 546-6400
- NPI assigned
- Mar 26, 2020
- Organization subpart
- No
Authorized official
- Name
- William Pelot
- Title
- Chief Administrator Officer
- Phone
- (410) 543-7497
Practitioners 103
-
Kristen Renee Abbott, CRNP
-
Nicole M Alu, DO
-
John A Appiott, D.O.
-
Jordan Pearson Braniff, FNP-C
-
Cynthia Calixte, M.D.
-
Edwin Tatoy Castaneda, M.D.
-
Mary Cherry, CRNP
-
Susanne Curry, FNP-BC
-
Anastasiya Deem, DNP-FNP, CRNP, RN
-
Alison L. Diesel, PA-C
-
Tammy Lynn Donoway, D.O.
-
Munna Garg, MD
-
Amy S. Johnson, M.D.
-
Craig Johnson, PA-C
-
Geetanjali Johri, M.D.
-
Sufyan Mustafa Malik, M.D.
-
Mary Darden Mason, DNP, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD, DE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200714000016 | MD | Part B Supplier - Clinic/Group Practice | 7911320635 |
Receives reassigned benefits from 86 practitioners Practice locations: Salisbury, MD; Snow Hill, MD; Crisfield, MD; Berlin, MD; Pocomoke, MD |
| O20200714000120 | DE | Part B Supplier - Clinic/Group Practice | 7911320635 |
Receives reassigned benefits from 21 practitioners Practice locations: Millsboro, DE |
National Provider Directory
Locations
145 E Carroll St
#23A1
Salisbury, MD 21801
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Community Health Clinic/Center | 261QC1500X |
Addresses
Primary practice location
100 E Carroll St
Salisbury, MD 21801-5422
Mailing address
100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 912-4976
Other practice location 1
30265 Commerce Dr
Suite 206
Millsboro, DE 19966-3595
Phone (302) 732-8400
Other practice location 2
305 10th St Ste 101
Pocomoke City, MD 21851-1607
Phone (410) 912-4950
Other practice location 3
11101 Cathage Rd
Ocean Pines, MD 21811-2115
Phone (410) 912-6104
Other practice location 4
145 E Carroll St
Salisbury, MD 21801-5454
Phone (410) 912-5785
Other practice location 5
100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 912-6400
Other practice location 6
1639 Woodbrooke Dr
Salisbury, MD 21804-8502
Phone (410) 912-5785
Other practice location 7
201 Hall Hwy
Crisfield, MD 21817-1237
Phone (410) 968-1801
Other practice location 8
9950 N Main St
Berlin, MD 21811-1076
Phone (410) 912-6710
Other practice location 9
428 W Market St
Snow Hill, MD 21863-1127
Phone (410) 912-4950
Other names
- TidalHealth Community Wellness
Other providers in Salisbury, MD
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Primary Care, LLC
- Tidalhealth Primary Care, LLC
- Tidalhealth Primary Care, LLC
- Tidalhealth Primary Care, LLC
- Tidalhealth Primary Care, LLC
All providers in Salisbury, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.