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General NPI Number Information
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NPI Number | 1710991153
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Entity Type | Organization
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Legal Business Name | TIDEWATER EMERGENCY MEDICAL CARE, LTD.
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 736 BATTLEFIELD BLVD N EMERGENCY DEPARTMENT
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4941
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Country | US
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Telephone | 757-490-9388
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Fax | 757-490-9401
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Provider Business Mailing Address
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Address Line | 109G GAINSBOROUGH SQ BOX 723
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-490-9388
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Fax | 757-490-9401
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | LEWIS SIEGEL
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Credential | M.D.
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Telephone | 757-449-2664
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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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