Tisdell, Jonathan M
Tisdell, Jonathan M is an individual health care provider with primary practice located at 123 Summer St Ste 660 , Worcester MA 01608-1216. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Clinical Neurophysiology. Allopathic & Osteopathic Physicians / Clinical Neurophysiology is his primary health care specialty. Tisdell, Jonathan M can be contacted via phone (508) 363-9030.Contact Information
Primary practice address
123 Summer St Ste 660
Worcester MA 01608-1216
Phone: (508) 363-9030
Fax: (508) 363-9037
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 248639 | Massachusetts |
| Allopathic & Osteopathic Physicians / Clinical Neurophysiology | 2084N0600X | 248639 | Massachusetts |
Profile Details
| NPI number | 1528235447 |
|---|---|
| LBN Legal business name | Tisdell, Jonathan M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 9th, 2008 |
| Last updated | Dec 21st, 2020 - about 6 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 | 1528235447 | NPPES |
| Massachusetts | MEDICAID | 110092622A |
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