Provider Type Icon

COLON RECTAL SURGERY OF TIDEWATER P.C. NPI 1790794022


NPI Information

NPI: 1790794022
Provider Name: COLON RECTAL SURGERY OF TIDEWATER, P.C.
Classification: Colon & Rectal Surgery - 208C00000X
Entity Type: Organization
Address:
3235 ACADEMY AVE
SUITE 100
PORTSMOUTH, VA
ZIP 23703
Phone: (757) 484-9653
Get Directions

COLON RECTAL SURGERY OF TIDEWATER, P.C. is a colon rectal surgery in Portsmouth, VA. The provider is a colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. COLON RECTAL SURGERY OF TIDEWATER, P.C. NPI is 1790794022. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3235 ACADEMY AVE
SUITE 100
PORTSMOUTH, VA
ZIP 23703-200
Phone: (757) 484-9653
Fax: (757) 484-9662

The provider's authorized official is Jeffrey Stephen Wolf .
The authorized official title is President and has the following contact phone number (757) 484-9653.

The enumeration date for this NPI number is 8/5/2006 and was last updated on 9/14/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208C00000XColon & Rectal Surgery0101031444VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100V712C97MEDICARE ID-TYPE UNSPECIFIEDVIRGINIA
2280000251MEDICARE ID-TYPE UNSPECIFIEDVIRGINIAMEDICARE RAILROAD
3200136OTHERVIRGINIAOPTIMA
42317306MEDICARE PINNORTH CAROLINA
5B07424MEDICARE UPINVIRGINIA
6072337OTHERVIRGINIABC/BS
7292832OTHERVIRGINIAMAMSI
8890528EMEDICAIDNORTH CAROLINA
9005841232MEDICAIDVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.