Healthcare Provider Details

I. General information

NPI: 1710991153
Provider Name (Legal Business Name): TIDEWATER EMERGENCY MEDICAL CARE, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 11/15/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 BATTLEFIELD BLVD N EMERGENCY DEPARTMENT
CHESAPEAKE VA
23320-4941
US

IV. Provider business mailing address

109G GAINSBOROUGH SQ BOX 723
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-9388
  • Fax: 757-490-9401
Mailing address:
  • Phone: 757-490-9388
  • Fax: 757-490-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LEWIS SIEGEL
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 757-449-2664