Healthcare Provider Details

I. General information

NPI: 1306590450
Provider Name (Legal Business Name): OBSERVATION PHYSICIANS OF TIDEWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 KEMPSVILLE RD
NORFOLK VA
23502-3920
US

IV. Provider business mailing address

6379 CENTER DR
NORFOLK VA
23502-4102
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-6000
  • Fax:
Mailing address:
  • Phone: 757-467-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: THEODORE TZAVARAS
Title or Position: AO
Credential: MD
Phone: 757-467-4200