49D2101100 CLIA NUMBER - TIDEWATER KIDNEY SPECIALISTS, INC

Laboratory Demographics

  • CLIA Code: 49D2101100
  • Facility Name: TIDEWATER KIDNEY SPECIALISTS, INC
  • Facility Address: 828 HEALTHY WAY - SUITE 270
    VIRGINIA BEACH, VA
    ZIP 23462
  • Facility Phone: 757 623-0005
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MADHU K. KOLLI
  • NPI Number: 1700830742
  • Taxonomy: 104100000X - Social Worker

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CLIA Record

Field Name Field Value
CLIA Number 49D2101100
LAB Type Physician Office
Facility Name TIDEWATER KIDNEY SPECIALISTS, INC
Street 828 HEALTHY WAY - SUITE 270
City VIRGINIA BEACH
State VA
ZIP 23462
Phone 757 623-0005
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/27/2025
Certificate Expiration Date 8/26/2027
Facility Type Physician Office
Lab Director MADHU K. KOLLI

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