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General NPI Number Information
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NPI Number | 1518154947
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Entity Type | Organization
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Legal Business Name | EMERGENCY PHYSICIANS OF TIDEWATER, PC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 4092 FOXWOOD DR SUITE 101
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5225
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Country | US
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Telephone | 757-467-4200
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Fax | 757-467-4173
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Provider Business Mailing Address
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Address Line | PO BOX 7549
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City | PORTSMOUTH
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State | VA
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Zip | 23707-0549
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Country | US
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Telephone | 757-686-3515
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Fax | 757-686-0541
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROBERT HUNDLEY
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Credential |
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Telephone | 616-464-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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