NPIMap

Organization Active NPI

Tidalhealth Primary Care, LLC

  • Family Medicine Physician
  • Salisbury, MD
National Provider Identifier
1114784188
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TIDALHEALTH PRIMARY CARE, LLC
Practice address
560 Riverside Dr Ste B204
Salisbury, MD 21801-4703
Phone
(410) 543-7720
NPI assigned
Mar 5, 2024
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 Administrator Officer
Phone
(410) 543-7497

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

560 Riverside Dr Ste B204
Salisbury, MD 21801-4703

Mailing address

560 Riverside Dr Ste B204
Salisbury, MD 21801-4703
Phone (410) 543-7720

Other names 1

  • TidalHealrh Family Medicine Practice Other name

National Provider Directory

National Provider Directory
Tax ID family
Tidalhealth Primary Care LLC23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

560 Riverside Dr
Ste B204
Salisbury, MD 21801
Phone (410) 543-7720

NPI Registry JSON

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1114784188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 RIVERSIDE DR STE B204",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218014703",
            "telephone_number": "410-543-7720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 RIVERSIDE DR STE B204",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218014703",
            "telephone_number": "410-543-7720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "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 ADMINISTRATOR OFFICER",
        "authorized_official_telephone_number": "410-543-7497"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealrh Family Medicine Practice",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TidalHealrh Family Medicine Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Salisbury, 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.