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Contact Information

TIDALHEALTH PENINSULA REGIONAL, INC.
11101 CATHAGE RD
BERLIN, MD21811
 Phone: 410-543-4769
 Fax: 410-543-4770
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for TIDALHEALTH PENINSULA REGIONAL, INC.

NPI Number 1851795017
LBN Legal business name TIDALHEALTH PENINSULA REGIONAL, INC.
Authorized official KEVIN JOHNSON - (DIRECTOR OF AMBULATORY PHARMACY SVC)
Entity Organization
Organization subpart 1 No
Enumeration date 10/17/2014
Last updated 03/02/2026 - About 3 months ago
Identifiers
MD License # P06935
Other 2153648 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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