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General NPI Number Information
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NPI Number | 1104461896
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Entity Type | Organization
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Legal Business Name | LUNG SPECIALISTS OF TIDEWATER PLLC
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Dates
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Enumeration Date | 11/17/2019
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 224 AVONLEA POINTE
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City | CHESAPEAKE
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State | VA
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Zip | 23322-4279
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Country | US
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Telephone | 757-354-7405
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Fax |
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Provider Business Mailing Address
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Address Line | 224 AVONLEA POINTE
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City | CHESAPEAKE
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State | VA
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Zip | 23322-4279
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Country | US
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Telephone | 757-354-7405
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN, OPERATING MANAGER
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Name | DR. HIMANSHU DESAI
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Credential | MD
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Telephone | 757-354-7405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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