Dr. Avian L Tisdale, MD
Pediatrics in Atlantic City, New Jersey
1740297076- Practice location
- 1925 Pacific Ave., Atlantic City, NJ 08401-6713
- Phone
- 609-441-8087
- Fax
- 302-651-4945
- Last updated
- March 18, 2021
Avian L. Tisdale is a Pediatrics based in Atlantic City, NJ. Avian L. Tisdale practices in Atlantic City, NJ and has the professional credentials of MD. The NPI Number for Avian L. Tisdale is 1740297076 and holds a License No. 25MA08575900 (NJ). The current practice location address for Avian L. Tisdale is 1925 Pacific Ave., Atlantic City, NJ 08401-6713 and can be reached out via phone at 609-441-8087 and via fax at 302-651-4945.
Provider Profile Details
- NPI Number
- 1740297076
- Provider Name
- Avian L. Tisdale
- Credential
- MD
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 1925 Pacific Ave., Atlantic City, NJ 08401-6713
- Phone Number
- 609-441-8087
- Fax Number
- 302-651-4945
- Primary Taxonomy
- Pediatrics · 208000000X
- Sole Proprietor
- No
- Other Names
- Dr. Avian West, MD (Former Name)
- Provider Enumeration Date
- August 1, 2006
- Last Update Date
- March 18, 2021
- Certification Date
- March 18, 2021
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1925 Pacific Ave.
Atlantic City, NJ 08401-6713 - City
- Atlantic City
- State
- New Jersey
- Zip
- 08401-6713
- Phone Number
- 609-441-8087
- Fax Number
- 302-651-4945
Provider Business Mailing Address Details
- Address
- P.o. Box 191
Rockland, DE 19723-0191 - City
- Rockland
- State
- DE
- Zip
- 19723-0191
- Phone Number
- 302-651-4000
- Fax Number
- 302-651-4945
License Information
- License Number (1)
- 25MA08575900
- License State (1)
- NJ
- Taxonomy (1)
- Emergency Medicine · 207P00000X
- License Number (2)
- 25MA08575900
- License State (2)
- NJ
- Taxonomy (2)
- Hospitalist · 208M00000X
- License Number (3)
- R7343
- License State (3)
- TX
- Taxonomy (3)
- Pediatrics · 208000000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Pediatrics providers near Atlantic City, NJ
View all Pediatrics providers in Atlantic City →Frequently Asked Questions
What is the NPI number of Dr. Avian L Tisdale, MD?
The NPI number of Dr. Avian L Tisdale, MD is 1740297076. It was assigned on August 1, 2006 and is currently active in the NPPES registry.
What is the specialty of Dr. Avian L Tisdale, MD?
Dr. Avian L Tisdale, MD is registered under the primary taxonomy Pediatrics (code 208000000X), licensed in NJ under license number 25MA08575900.
Where does Dr. Avian L Tisdale, MD practice?
The practice location is 1925 Pacific Ave., Atlantic City, NJ 08401-6713. The office can be reached at 609-441-8087 (phone) or 302-651-4945 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1740297076 directly on the NPPES registry website.