=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306590450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OBSERVATION PHYSICIANS OF TIDEWATER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2022
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 KEMPSVILLE RD
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-3920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-261-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6379 CENTER DR
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-467-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AO
-----------------------------------------------------
Name | THEODORE TZAVARAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 757-467-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------