NPIMap

Organization Active NPI

Tidalhealth Specialty Care, LLC

  • Urology Physician
  • Salisbury, MD
National Provider Identifier
1174347330
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
TIDALHEALTH SPECIALTY CARE, LLC
Practice address
1664 Woodbrooke Dr
Salisbury, MD 21804
Phone
(410) 912-6716
NPI assigned
Nov 13, 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 Administrative Officer
Phone
(410) 543-7497

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1664 Woodbrooke Dr
Salisbury, MD 21804

Mailing address

PO Box 825461 N/a
Philadelphia, PA 19182-0001
Phone (410) 912-6053

Other names 1

  • Tidalhealth Specialtyy Care 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 24

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

View all 24

Locations

1664 Woodbrooke Dr
Salisbury, MD 21804
Phone (410) 912-6716

NPI Registry JSON

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

{
    "created_epoch": "1731456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1174347330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 825461 N/A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191820001",
            "telephone_number": "410-912-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1664 WOODBROOKE DR",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21804",
            "telephone_number": "410-912-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-13",
        "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": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidalhealth Specialtyy Care",
            "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.