# EMERGENCY PHYSICIAN OF TIDEWATER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851488167
- **Authorized official:** MR. AKSEL KEKLIK PA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (757) 410-8879

## Contact information

- **Practice address:** 4092 FOXWOOD DR, SUITE 101, VIRGINIA BEACH, VA 23462-5225
- **Practice address phone:** (757) 467-4200
- **Practice address fax:** (757) 467-4173
- **Mailing address:** 309 DOWNING DR, CHESAPEAKE, VA 23322-8703
- **Mailing address phone:** (757) 410-8879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 0110001528 | VA | Yes |

## Other

- **Enumeration date:** 10/06/2006
- **Last updated:** 08/22/2020