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Organization
TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC
Active
Organization
TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA WALKER (CREDENTIALING MANAGER)
(757) 232-8769
Entity
Organization
Contact information
Practice address
860 OMNI BLVD STE 401, NEWPORT NEWS, VA 23606-4430
(757) 232-8764
Mailing address
11761 ROCK LANDING DR STE 8, NEWPORT NEWS, VA 23606-4235
(757) 232-8769
(757) 232-8875
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701001988
VA
Other
Enumeration date
06/05/2015
Last updated
11/09/2021
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