David Eugene Tisdale, R-PCA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002506 Issued in NY

Practice address

1 Hospital Dr
Massena, NY 13662-1056

Phone

(315) 769-4200

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423180800000",
    "number": "1396835112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621056",
            "telephone_number": "315-769-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621056",
            "telephone_number": "315-769-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "DAVID",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "R-PCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "002506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LISCENCE",
            "identifier": "02506",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03773219",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Vincent Tarnow, A.P.
• Robin G Taylor
• Patricia H. Tharrett, MPT
• Krystal L Thompson, MD
• Michael Charles Thompson, PT
• Laura Ruth Todd, LCSW
• Town of Massena
• Town of Massena
• Tri-Lakes Home Medical Equipment, Inc.
• Alanna Laurel Tyo

• Physician Assistant in Massena, NY
• Providers in Massena, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; 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.