Organization
TIDEWATER EAR, NOSE, & THROAT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA WRENN MURDEN (INSURANCE COORDINATOR)
(757) 488-2080
Entity
Organization
Contact information
Practice address
4020 RAINTREE RD, SUITE C, CHESAPEAKE, VA 23321-3749
(757) 488-2080
(757) 405-3025
Mailing address
4020 RAINTREE RD, SUITE C, CHESAPEAKE, VA 23321-3749
(757) 488-2080
(757) 405-3025
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101016485
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006501320
—
VA
Enumeration date
02/26/2007
Last updated
07/09/2009
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