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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
CECILIA C QUINTERO (CREDENTIALING COORDINATOR)
(757) 964-8739
Entity
Organization
Contact information
Practice address
860 OMNI BLVD STE 401, NEWPORT NEWS, VA 23606-4430
(757) 232-8764
Mailing address
860 OMNI BLVD STE 128, NEWPORT NEWS, VA 23606-4483
(757) 232-8769
(757) 232-8875
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
182340975
VA
207RG0100X
Gastroenterology Physician
—
NULL
207RG0100X
Gastroenterology Physician
—
—
207RN0300X
Nephrology Physician
223741512
VA
207RR0500X
Rheumatology Physician
229641543
VA
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
NULL
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
NULL
208800000X
Urology Physician
—
—
213ES0131X
Foot Surgery Podiatrist
0103300835
VA
291U00000X
Clinical Medical Laboratory
—
NULL
Other
Enumeration date
06/12/2006
Last updated
06/12/2025
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