MEDICARE: DR. GEORGE F TIDEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VE0102X	Reproductive Endocrinology Physician	0101042835	VA

General Provider Information

NPI Number	:	1609931112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE F TIDEY M.D.

Provider Business Mailing Address
First Line	:	9030 STONY POINT PKWY STE 450
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1941
Country	:	US
Telephone Number	:	804-379-9000
Fax Number	:	804-323-0236

Provider Business Practice Location Address
First Line	:	9030 STONY POINT PKWY STE 450
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1941
Country	:	US
Telephone Number	:	804-379-9000
Fax Number	:	804-323-0236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	03/19/2019

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