Organization
TIDEWATER MEDICAL CARE PC
Active
Other names
Tidewater Medical Care PC
Organization subpart
No
Provider details
NPI number
Authorized official
MIGDONIA MONTEJO M.D. (OWNER/PRESIDENT)
(757) 965-9465
Entity
Organization
Contact information
Practice address
4608 THOROUGHGOOD DRIVE, VIRGINIA BEACH, VA 23455
(757) 965-9465
(757) 965-9491
Mailing address
4608 THOROUGHGOOD DRIVE, VIRGINIA BEACH, VA 23455
(757) 965-9465
(757) 965-9491
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101058505
VA
Other
Enumeration date
01/14/2009
Last updated
02/03/2010
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