Organization
TIDEWATER PEDIATRICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAARNI SERQUINA BIBAY (PRESIDENT)
(757) 399-5300
Entity
Organization
Contact information
Practice address
301 GOODE WAY STE 203, PORTSMOUTH, VA 23704-2266
(757) 399-5300
Mailing address
301 GOODE WAY STE 203, PORTSMOUTH, VA 23704-2266
(757) 399-5300
(757) 399-5987
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841206166
—
VA
Enumeration date
02/15/2019
Last updated
02/15/2019
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