MEDICARE: TIDEWATER SURGICAL SPECIALISTS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician
2	208C00000X	Colon & Rectal Surgery Physician

General Provider Information

NPI Number	:	1770519381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIDEWATER SURGICAL SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	3205 CHURCHLAND BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5262
Country	:	US
Telephone Number	:	757-483-3030
Fax Number	:	757-484-7239

Provider Business Practice Location Address
First Line	:	3205 CHURCHLAND BLVD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5262
Country	:	US
Telephone Number	:	757-483-3030
Fax Number	:	757-484-7239

Authorized Official
Title or Position	:	CEO
Name	:	RAY T. RAMIREZ
Credential	:	M.D.
Telephone Number	:	757-483-3030

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	09/11/2025

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