NPIMap

Organization Active NPI

Tidalhealth Specialty Care, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Salisbury, MD
National Provider Identifier
1245855196
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
TIDALHEALTH SPECIALTY CARE, LLC
Practice address
1639 Woodbrooke Dr
Salisbury, MD 21804-8502
Phone
(410) 912-7234
Fax
(410) 572-6890
NPI assigned
Jun 16, 2020
Organization subpart
Yes
Parent organization
TIDALHEALTH SPECIALTY CARE, LLCAs reported in NPPES

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
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X Primary

Addresses

Primary practice location

1639 Woodbrooke Dr
Salisbury, MD 21804-8502

Mailing address

PO Box 825461
Philadelphia, PA 19182-5461

Other practice location 1

100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 912-6400

Other practice location 2

11107 Cathage Road
Suite 201
Berlin, MD 21811-2156
Phone (410) 629-0888

Other names 1

  • TidalHealth Endocrinology Other name

National Provider Directory

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

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

1415 S Division St
Ste A
Salisbury, MD 21804
Phone (410) 572-8848

NPI Registry JSON

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1245855196",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 WOODBROOKE DR",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218048502",
            "telephone_number": "410-912-7234",
            "fax_number": "410-572-6890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 E Carroll St",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218015422",
            "country_code": "US",
            "telephone_number": "410-912-6400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11107 Cathage Road",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Berlin",
            "state": "MD",
            "postal_code": "218112156",
            "country_code": "US",
            "telephone_number": "410-629-0888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIDALHEALTH SPECIALTY CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIDALHEALTH SPECIALTY CARE, LLC",
        "enumeration_date": "2020-06-16",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealth Endocrinology",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TidalHealth Endocrinology",
            "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.