Organization
TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC
Active
Organization
TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CECILIA QUINTERO (CREDENTIALING MANAGER)
(757) 964-8739
Entity
Organization
Contact information
Practice address
4421 VIRGINIA BEACH BLVD STE 114, VA BEACH, VA 23462-3114
(757) 963-7676
(757) 937-0104
Mailing address
860 OMNI BLVD STE 8, NEWPORT NEWS, VA 23606-4434
(757) 964-8739
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/08/2023
Last updated
03/11/2026
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