Organization
TIDEWATER DERMATOPATHOLOGY SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT J. PARISER M.D. (PRESIDENT)
(757) 622-6315
Entity
Organization
Contact information
Practice address
601 MEDICAL TOWER, NORFOLK, VA 23507
(757) 622-6315
Mailing address
601 MEDICAL TOWER, NORFOLK, VA 23507
(757) 622-6315
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
0101-027130
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4980662
—
VA
01
—
49D0229705
CLIA ID NUMBER
VA
Enumeration date
10/13/2006
Last updated
05/16/2011
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