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General NPI Number Information
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NPI Number | 1770519381
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Entity Type | Organization
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Legal Business Name | TIDEWATER SURGICAL SPECIALISTS, PLLC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3205 CHURCHLAND BLVD
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5262
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Country | US
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Telephone | 757-483-3030
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Fax | 757-484-7239
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Provider Business Mailing Address
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Address Line | 3205 CHURCHLAND BLVD
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5262
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Country | US
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Telephone | 757-483-3030
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Fax | 757-484-7239
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Authorized Official
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Title or Position | CEO
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Name | RAY T. RAMIREZ
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Credential | M.D.
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Telephone | 757-483-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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