| Tida Healthcare Llc | |
|
2209 Montauk Dr Crofton MD 21114-3245 | |
| (443) 570-7610 | |
| Not Available |
| Full Name | Tida Healthcare Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2209 Montauk Dr, Crofton, Maryland |
| Authorized Official Name and Position | Ida Konchou (CEO) |
| Authorized Official Contact | 4435707610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tida Healthcare Llc 2209 Montauk Dr Crofton MD 21114-3245 Ph: (443) 570-7610 | Tida Healthcare Llc 2209 Montauk Dr Crofton MD 21114-3245 Ph: (443) 570-7610 |
| NPI Number | 1902549728 |
|---|---|
| Provider Enumeration Date | 04/19/2022 |
| Last Update Date | 06/02/2022 |
| Certification Date | 06/02/2022 |
| Medicare PECOS PAC ID | 3375923865 |
|---|---|
| Medicare Enrollment ID | O20220629003826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902549728 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ida M Konchou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134482078 PECOS PAC ID: 6608291190 Enrollment ID: I20200730002814 |
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