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General NPI Number Information
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NPI Number | 1295822351
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY ASSOCIATES OF TIDEWATER, INC.
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 09/22/2012
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Provider Practice Location Address
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Address Line | 300 MEDICAL PKWY SUITE 316
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4985
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Country | US
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Telephone | 757-547-0047
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Fax | 757-548-3370
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Provider Business Mailing Address
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Address Line | 300 MEDICAL PKWY SUITE 316
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4985
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Country | US
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Telephone | 757-547-0047
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Fax | 757-548-3370
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH CRAIG MERRELL
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Credential | M.D.,FACS
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Telephone | 757-673-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 05286935
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License Number State | VA
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