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General NPI Number Information
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NPI Number | 1700938750
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Entity Type | Organization
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Legal Business Name | PULMONARY CONSULTANTS OF TIDEWATER PC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 113 GAINSBOROUGH SQ SUITE 300
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City | CHESAPEAKE
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State | VA
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Zip | 23320-1713
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Country | US
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Telephone | 757-547-9451
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Fax | 757-547-1405
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Provider Business Mailing Address
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Address Line | 113 GAINSBOROUGH SQ SUITE 300
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City | CHESAPEAKE
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State | VA
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Zip | 23320-1713
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Country | US
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Telephone | 757-547-9451
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Fax | 757-547-1405
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN HOWARD KAUFMAN
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Credential | MD
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Telephone | 757-547-9451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0101031986
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License Number State | VA
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