NPIMap

Organization Active NPI

Tidalhealth Specialty Care, LLC

  • Specialist
  • Berlin, MD
National Provider Identifier
1629930763
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
TIDALHEALTH SPECIALTY CARE, LLC
Practice address
9714 Healthway Dr
Berlin, MD 21811-1154
Phone
(410) 641-4765
NPI assigned
Nov 26, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Authorized official

Name
Sloan Trammell
Title
Credentialing Manager
Phone
(410) 912-6989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

9714 Healthway Dr
Berlin, MD 21811-1154

Mailing address

PO Box 825461
Philadelphia, PA 19182-5461

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

NPI Registry JSON

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

{
    "created_epoch": "1764115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1629930763",
    "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": "9714 HEALTHWAY DR",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111154",
            "telephone_number": "410-641-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-26",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "TRAMMELL",
        "authorized_official_first_name": "SLOAN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "410-912-6989"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.