Healthcare Provider Details

I. General information

NPI: 1437344306
Provider Name (Legal Business Name): TIDEWATER INTERNAL MEDICINE AND HYPERTENSION CENTER. PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SMOKEY MOUNTAIN TRL
CHESAPEAKE VA
23320-8147
US

IV. Provider business mailing address

1100 SMOKEY MOUNTAIN TRL STE 102
CHESAPEAKE VA
23320-8147
US

V. Phone/Fax

Practice location:
  • Phone: 757-351-3400
  • Fax: 757-351-3400
Mailing address:
  • Phone: 757-351-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JIEMING YAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-351-3400