Organization
EAR,NOSE&THROAT OF TIDEWATER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN PATRICK LYLE MD (PRESIDENT)
(757) 934-7753
Entity
Organization
Contact information
Practice address
2790 GODWIN BLVD, SUITE 205, SUFFOLK, VA 23434-8151
(757) 934-7753
Mailing address
1109 PINE VALLEY DR, SUFFOLK, VA 23434-6232
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Enumeration date
10/18/2006
Last updated
08/22/2020
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