Organization
COLON RECTAL SURGERY OF TIDEWATER, P.C.
Active
Organization
COLON RECTAL SURGERY OF TIDEWATER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY STEPHEN WOLF M.D. (PRESIDENT)
(757) 484-9653
Entity
Organization
Contact information
Practice address
3235 ACADEMY AVE, SUITE 100, PORTSMOUTH, VA 23703-3200
(757) 484-9653
(757) 484-9662
Mailing address
3235 ACADEMY AVE, SUITE 100, PORTSMOUTH, VA 23703-3200
(757) 484-9653
(757) 484-9662
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
0101031444
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005841232
—
VA
01
—
072337
BC/BS
VA
01
—
200136
OPTIMA
VA
01
—
292832
MAMSI
VA
05
—
890528E
—
NC
Enumeration date
08/05/2006
Last updated
09/14/2011
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