Healthcare Provider Details

I. General information

NPI: 1518990423
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF TIDEWATER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 KEMPSVILLE CIRCLE SUITE 302A
NORFOLK VA
23502-3936
US

IV. Provider business mailing address

6160 KEMPSVILLE CIRCLE SUITE 302A
NORFOLK VA
23502-3936
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-9288
  • Fax: 757-457-3691
Mailing address:
  • Phone: 757-466-9288
  • Fax: 757-457-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY M HANKINS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 757-466-9288