49D2051886 CLIA NUMBER - TIDEWATER HOME DIALYSIS

Laboratory Demographics

  • CLIA Code: 49D2051886
  • Facility Name: TIDEWATER HOME DIALYSIS
  • Facility Address: 230 CLEARFIELD AVENUE - SUITE 106
    VIRGINIA BEACH, VA
    ZIP 23462
  • Facility Phone: 757 518-9439
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MADHU KOLLI
  • NPI Number: 1609110758
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2051886
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name TIDEWATER HOME DIALYSIS
Street 230 CLEARFIELD AVENUE - SUITE 106
City VIRGINIA BEACH
State VA
ZIP 23462
Phone 757 518-9439
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2025
Certificate Expiration Date 1/1/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MADHU KOLLI

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This page was last updated on: 9/29/2025