Brown-Tisdale, Chuckia Nicole
Brown-Tisdale, Chuckia Nicole is an sole proprietor health care provider with primary practice located at 11110 Medical Campus Rd Ste 143 , Hagerstown MD 21742-6755. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Brown-Tisdale, Chuckia Nicole can be contacted via phone (301) 714-4175.Contact Information
Primary practice address
11110 Medical Campus Rd Ste 143
Hagerstown MD 21742-6755
Phone: (301) 714-4175
Fax: (301) 714-4183
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | D0063718 | Maryland |
Profile Details
| NPI number | 1306836804 |
|---|---|
| LBN Legal business name | Brown-Tisdale, Chuckia Nicole |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 26th, 2005 |
| Last updated | Jan 20th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306836804 | NPPES |
| Maryland | MEDICAID | 409370400 |
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