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General NPI Number Information
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NPI Number | 1356542922
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Entity Type | Organization
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Legal Business Name | TIDEWATER PODIATRY GROUP LTD
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 6161 KEMPSVILLE CIR STE 230
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City | NORFOLK
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State | VA
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Zip | 23502-3932
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Country | US
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Telephone | 757-481-6248
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Fax |
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Provider Business Mailing Address
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Address Line | 6161 KEMPSVILLE CIR STE 230
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City | NORFOLK
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State | VA
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Zip | 23502-3932
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Country | US
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Telephone | 757-481-6248
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY TISCHLER
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Credential | DPM
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Telephone | 757-481-6248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State | VA
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