# TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC

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

## Provider details

- **NPI number:** 1902848294
- **Authorized official:** CECILIA C QUINTERO (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (757) 964-8739

## Contact information

- **Practice address:** 860 OMNI BLVD STE 401, NEWPORT NEWS, VA 23606-4430
- **Practice address phone:** (757) 232-8764
- **Mailing address:** 860 OMNI BLVD STE 128, NEWPORT NEWS, VA 23606-4483
- **Mailing address phone:** (757) 232-8769
- **Mailing address fax:** (757) 232-8875

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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