John Scott Tidball, MD, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D52196 Issued in MD

Legal business name

JOHN SCOTT TIDBALL, MD, PC

Doing business as

Wildewood Medical Care

Practice address

23415 Three Notch Rd
Ste 2054 Wildewood Ctr
California, MD 20619-4017

Phone

(301) 737-7833

Fax

(301) 737-4865

NPI assigned

Nov 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Scott Tidball, MD

Title

Owner

Phone

(301) 737-7833

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wildewood Medical Care Doing business as

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1770659609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23415 THREE NOTCH RD",
            "address_2": "STE 2054 WILDEWOOD CTR",
            "city": "CALIFORNIA",
            "state": "MD",
            "postal_code": "206194017",
            "telephone_number": "301-737-7833",
            "fax_number": "301-737-4865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23415 THREE NOTCH RD",
            "address_2": "STE 2054 WILDEWOOD CTR",
            "city": "CALIFORNIA",
            "state": "MD",
            "postal_code": "206194017",
            "telephone_number": "301-737-7833",
            "fax_number": "301-737-4865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN SCOTT TIDBALL, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "TIDBALL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-737-7833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D52196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "138950500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wildewood Medical Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Jeffries
• Laice Lanette Jeffries, O.D.
• Jenny O. Hawkins DDS PC
• Rita Jhaveri
• Jenita Ann Joe, MD
• Anh Bui Johnsen
• Kiara Johnson
• Madisyn Jones
• Rebakah Amanda Jones, LMT, ICT, CST, MMP
• Jena Marie Jung, O.D.

• Family Medicine Physician in California, MD
• Providers in California, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.