Organization
TIDEWATER DIAGNOSTIC INTERPRETERS,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA BASS LANE (BILLING MANAGER)
(757) 238-9401
Entity
Organization
Contact information
Practice address
2994 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5643
(757) 484-5264
(757) 686-8156
Mailing address
PO BOX 5391, PORTSMOUTH, VA 23703-1391
(757) 238-9401
(757) 686-8156
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031305
ANTHEM
VA
01
—
CB8291
RAILROAD MEDICARE
—
Enumeration date
03/11/2008
Last updated
04/15/2008
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