TIDALHEALTH SPECIALTY CARE, LLC (NPI# 1487279337) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487279337 |
| Entity Type | Organization |
| Organization Name | TIDALHEALTH SPECIALTY CARE, LLC |
| Practice Address |
1630 Woodbrooke Dr Salisbury MD 21804-8501 |
| Mailing Address |
Po Box 2498 Salisbury MD 21802-2498 |
| Practice Telephone | 4109126330 |
| Practice Fax Number | 4109126331 |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |
| Authorized Official Name | KARIN DIBARI (PRESIDENT) |
| Authorized Official Telephone | 6035772799 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | TIDALHEALTH SPECIALTY CARE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| TidalHealth Neurosurgery | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992320840 | Tidalhealth Specialty Care, LLC | Internal Medicine | 560 Riverside Dr Ste A106, Salisbury, MD 21801-4702 | 2020-06-16 |
| 1245855196 | Tidalhealth Specialty Care, LLC | Internal Medicine | 1415 S Division St Ste A, Salisbury, MD 21804-7291 | 2020-06-16 |
| 1952926891 | Tidalhealth Specialty Care, LLC | Pediatrics | 100 E Carroll St, Salisbury, MD 21801-5422 | 2020-06-16 |
| 1013532969 | Tidalhealth Specialty Care, LLC | Internal Medicine | 560 Riverside Dr Ste A206, Salisbury, MD 21801-4704 | 2020-06-16 |
| 1053936906 | Tidalhealth Specialty Care, LLC | Internal Medicine | 314 Franklin Ave Ste 301, Berlin, MD 21811-1238 | 2020-06-16 |
| 1083239933 | Tidalhealth Specialty Care, LLC | Anesthesiology | 264 Tilghman Rd, Salisbury, MD 21804-1921 | 2020-06-16 |
| 1306461256 | Tidalhealth Specialty Care, LLC | Psychiatry & Neurology | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2020-06-16 |
| 1962027094 | Tidalhealth Specialty Care, LLC | Clinic/Center | 100 E Carroll St, Salisbury, MD 21801-5422 | 2020-06-15 |
| 1679198642 | Tidalhealth Specialty Care, LLC | Internal Medicine | 100 E Carroll St, Salisbury, MD 21801-5422 | 2020-06-15 |
| 1124643184 | Tidalhealth Specialty Care, LLC | Internal Medicine | 100 E Carroll St, Salisbury, MD 21801-5422 | 2020-06-15 |
| Street Address |
1630 WOODBROOKE DR |
| City | SALISBURY |
| State | MD |
| Zip Code | 21804-8501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164417499 | Robert Mark Paschall | Psychiatry & Neurology | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2005-09-13 |
| 1306461256 | Tidalhealth Specialty Care, LLC | Psychiatry & Neurology | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2020-06-16 |
| 1568013316 | Catherine Elaine Gannon | Nurse Practitioner | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2019-09-24 |
| 1396254314 | Michael David Cecil | Physician Assistant | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2017-09-21 |
| 1962742817 | Janet Marie Talley | Physician Assistant | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2013-02-28 |
| 1043320252 | Bothwell Graves Lee | Neurological Surgery | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2006-08-30 |
| 1972576981 | Andy Hugo Pierre | Neurological Surgery | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578125969 | Lifes Energy Wellness Center Inc. | Community/Behavioral Health | 2324 West Zion Road Suite, Suite 112, Salisbury, MD 21804 | 2019-07-05 |
| 1578125340 | Lifes Energy Wellness Center Inc. | Counselor | 2324 West Zion Road Suite 112, Suite 112, Salisbury, MD 21804 | 2019-07-02 |
| 1093377855 | Lifes Energy Wellness Center Inc. | Clinic/Center | 2324 West Zion Road Suite #112, Salisbury, MD 21804 | 2019-07-02 |
| 1356904874 | Carly Showell Finkbeiner | Behavioral Analyst | 30507 Foxchase Dr, Salisbury, MD 21804 | 2019-04-19 |
| 1750844940 | Clifton Waters | Driver | 206 Davis St, Salisbury, MD 21804 | 2019-04-13 |
| 1487125415 | Rebecca J. Raygor | Social Worker | Wicomico High School, 201 Long Ave., Salisbury, MD 21804 | 2018-12-17 |
| 1639662745 | Peninsula Physical Therapy, LLC | Physical Therapist | 720 E College Ave Ste 11, Salisbury, MD 21804 | 2018-06-13 |
| 1376079533 | Kerry Choplin | Behavior Technician | 8032 Snow Hill Rd., Salisbury, MD 21804 | 2017-05-10 |
| 1558892992 | Three Lower Counties Community Services, Inc. | Clinic/Center | 1647 Woodbrooke Drive, Salisbury, MD 21804 | 2017-03-27 |
| 1508304759 | Driven Physiotherapy, LLC | Clinic/Center | 1029 Zircon Ct., Salisbury, MD 21804 | 2017-02-08 |
| Find all providers in zip 21804 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275762429 | Larry Roland Shannon II | Neurological Surgery | 5771 Royal Mile Blvd, Salisbury, MD 21801-2326 | 2009-07-09 |
| 1639142763 | Julius David Zant | Neurological Surgery | 540 Snow Hill Rd, Salisbury, MD 21804-6031 | 2006-02-09 |
| 1205830221 | Ranjan Shanti Roy | Neurological Surgery | 330 Jake Alexander Blvd W, Ste 104, Salisbury, NC 28147-1385 | 2005-06-08 |
| 1336308071 | Sophia Shakur | Neurological Surgery | 540 Snow Hill Rd, Salisbury, MD 21804-6031 | 2008-06-06 |
| 1770771529 | Duane O Campbell | Neurological Surgery | 612 Mocksville Ave, Salisbury, NC 28144-2732 | 2007-10-05 |
| 1043320252 | Bothwell Graves Lee | Neurological Surgery | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2006-08-30 |
| 1487683629 | Muneshwar Devendra Tiwari | Neurological Surgery | 100 E Carroll St, Salisbury, MD 21801-5493 | 2006-07-01 |
| 1255370011 | Curtis Norman Nelson | Neurological Surgery | 540 Snow Hill Rd, Salisbury, MD 21804-6031 | 2006-06-06 |
| 1871566935 | Peninsula Neurosurgical Associates Pa | Neurological Surgery | 540 Snow Hill Rd, Salisbury, MD 21804-6031 | 2006-02-09 |
| 1972576981 | Andy Hugo Pierre | Neurological Surgery | 1630 Woodbrooke Dr, Salisbury, MD 21804-8501 | 2006-02-09 |
| Find all providers in SALISBURY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.