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TIDEWAY DERMATOLOGY, PA
NPI 1619054525
Specialist in Havre De Grace, MD

Active since November 01, 2006
323 S UNION AVE, HAVRE DE GRACE, MD 21078(410) 939-0961 Get Directions Write a Review

NPPES record last updated: July 26, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Tideway Dermatology, Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIDEWAY DERMATOLOGY, PA (NPI 1619054525) is a healthcare organization registered as a specialist in Havre De Grace, Maryland and active in the NPI registry since November 2006. The organization lists David Franklin Jaffe, Owner, as its authorized official.

NPPES Registry Identity

NPI1619054525
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameTIDEWAY DERMATOLOGY, PA
Location Address323 S UNION AVEHavre De Grace, MD 21078-3201
Mailing Address323 S Union AveHavre De Grace, MD 21078-3201 · (410) 939-0961
Phone(410) 939-0961
Organization SubpartNo
Authorized OfficialDavid Franklin JaffeOwner · (410) 939-0961
Enumeration DateNovember 1, 2006
Last NPPES UpdateJuly 26, 2016
✔ NPI 1619054525 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MD · D0045614
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

323 S UNION AVE, Havre De Grace, MD 21078
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Other Identifiers 1

Medicare UPINF77182MD

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DIANE CECILIA WILLIAMS PAC
Physician Assistant
323 S UNION AVE
HAVRE DE GRACE, MD 21078
Harford County (410) 939-0961

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tideway Dermatology, PA's NPI number?

The NPI number for Tideway Dermatology, PA is 1619054525. It was assigned to this organization in the NPPES registry on November 1, 2006.

Where is Tideway Dermatology, PA located?

Tideway Dermatology, PA is located at 323 S Union Ave, Havre De Grace, MD 21078. The listed phone number is (410) 939-0961.

What is Tideway Dermatology, PA's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Tideway Dermatology, PA was last updated on July 26, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.