Organization
CANCER SPECIALISTS OF TIDEWATER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARRIE ANN PERNELL (OFFICE MANAGER)
(757) 436-1492
Entity
Organization
Contact information
Practice address
110 WIMBLEDON SQ, SUITE E, CHESAPEAKE, VA 23320-4946
(757) 436-1492
(757) 436-2912
Mailing address
110 WIMBLEDON SQ, SUITE E, CHESAPEAKE, VA 23320-4946
(757) 436-1492
(757) 436-2912
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033518
ANTHEM
VA
01
—
093213
ANTHEM
VA
01
—
265950
ANTHEM
VA
01
—
35037
OPTIMA/SENTARA
VA
01
—
52831
OPTIMA/SENTARA
VA
05
—
58-45521
—
VA
05
—
60-48030
—
VA
01
—
830003514
RAILROAD MEDICARE
—
01
—
830007176
RAILROAD MEDICARE
—
01
—
890500W
NORTH CAROLINA MEDICAID
—
01
—
890511H
NORTH CAROLINA MEDICAID
—
01
—
890584T
NORTH CAROLINA MEDICAID
—
01
—
900001703
RAILROAD MEDICARE
—
Enumeration date
08/03/2006
Last updated
04/01/2010
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