| Wildewood Medical Care | |
|
23415 Three Notch Rd Ste 2054 Wildewood Ctr California MD 20619-4017 | |
| (301) 737-7833 | |
| (301) 737-4865 |
| Full Name | Wildewood Medical Care |
|---|---|
| Speciality | Family Medicine |
| Location | 23415 Three Notch Rd, California, Maryland |
| Authorized Official Name and Position | John Scott Tidball (OWNER) |
| Authorized Official Contact | 3017377833 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildewood Medical Care 23415 Three Notch Rd Ste 2054 Wildewood Ctr California MD 20619-4017 Ph: (301) 737-7833 | Wildewood Medical Care 23415 Three Notch Rd Ste 2054 Wildewood Ctr California MD 20619-4017 Ph: (301) 737-7833 |
| NPI Number | 1770659609 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 04/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770659609 | NPI | - | NPPES |
| 138950500 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D52196 (Maryland) | Primary |
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