Provider Demographics
NPI:1699722066
Name:TIDSWELL, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TIDSWELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT STREET
Practice Address - Street 2:S2668
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199
Practice Address - Country:US
Practice Address - Phone:413-794-5439
Practice Address - Fax:413-794-5389
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-04-01
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Provider Licenses
StateLicense IDTaxonomies
MA161219207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease