TIDEWATER NEUROLOGISTS INC (NPI# 1689623258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689623258 |
| Entity Type | Organization |
| Organization Name | TIDEWATER NEUROLOGISTS INC |
| Practice Address |
3235 Academy Ave Suite 305 Portsmouth VA 23703-3200 |
| Mailing Address |
2876 Guardian Lane Virginia Beach VA 23452-7327 |
| Practice Telephone | 7576869300 |
| Practice Fax Number | 7576861514 |
| Mailing Telephone | 7574635240 |
| Mailing Fax Number | 7574636572 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | HEMANG H SHAH (SECRETARY) |
| Authorized Official Telephone | 7576869300 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | SENTARA | 200250 | 01 |
| Street Address |
3235 ACADEMY AVE SUITE 305 |
| City | PORTSMOUTH |
| State | VA |
| Zip Code | 23703-3200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245238096 | Mark A Pavilack | Ophthalmology | 3235 Academy Ave, Suite 200, Portsmouth, VA 23703-3200 | 2005-07-13 |
| 1346470572 | Nancy D Myers | Physician Assistant | 3235 Academy Ave, Suite 101, Portsmouth, VA 23703-3200 | 2009-07-22 |
| 1245469964 | Tidewater Eye Centers | Ophthalmology | 3235 Academy Ave, Suite 200, Portsmouth, VA 23703-3200 | 2009-07-02 |
| 1871732784 | Churchland Family Medicine PC | Family Medicine | 3235 Academy Ave, Suite 102, Portsmouth, VA 23703-3200 | 2009-02-17 |
| 1235393059 | Krunal Manubhai Patel | Internal Medicine | 3235 Academy Ave, Suite 301, Portsmouth, VA 23703-3200 | 2008-07-10 |
| 1265691141 | Kori A Elkins | Ophthalmology | 3235 Academy Ave, Suite 200, Portsmouth, VA 23703 | 2008-06-05 |
| 1942488564 | Digitrace Care Services Inc | Durable Medical Equipment & Medical Supplies | 3235 Academy Ave, Suite 304, Portsmouth, VA 23703-3200 | 2008-02-06 |
| 1578750584 | Karen Diane Kahan | Nurse Practitioner | 3235 Academy Ave, Suite 305, Portsmouth, VA 23703-3200 | 2007-10-03 |
| 1548466238 | Digitrace Care Services Inc | Durable Medical Equipment & Medical Supplies | 3235 Academy Ave, Suite 304, Portsmouth, VA 23703-3200 | 2007-06-21 |
| 1083731525 | Jeffrey Stephen Wolf | Colon & Rectal Surgery | 3235 Academy Ave, Suite 200, Portsmouth, VA 23703-3200 | 2007-03-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174037444 | Kelly Foster | Massage Therapist | 3108 Tyre Neck Rd Ste D, Portsmouth, VA 23703 | 2017-11-25 |
| 1578072104 | Katherine Armstrong Wise | Behavior Technician | 3120 Verne Ave, Portsmouth, VA 23703 | 2017-09-27 |
| 1891223913 | Ashley Rebecca Anderson | Dentist | 5915 High Street W, Portsmouth, VA 23703 | 2017-06-02 |
| 1881126019 | Anas Elmahdi | Specialist | 5205 Sweetbriar C., 5205 Sweetbriar C., Portsmouth, VA 23703 | 2017-03-28 |
| 1578003554 | Elyse Buttery | Nurse Practitioner | Mast One 1040 University Blvd, Suite 200, Portsmouth, VA 23703 | 2017-02-24 |
| 1376948349 | Charles Douglas Knight | Military Health Care Provider | Uss Maryland Ssbn 738, Fpo, AA 23703 | 2014-11-03 |
| 1689929382 | Positive Connections, Inc | Community/Behavioral Health | 3823d Meherrin River Reach, Portsmouth, VA 23703 | 2012-07-18 |
| 1225319874 | Sanaz Namin | Pharmacist | 5601 High Street, Porstmouth, VA 23703 | 2011-09-08 |
| 1295029767 | Maggie Jackson | Dental Hygienist | 4000 Coast Guard Blvd., Portsmouth, VA 23703 | 2011-06-02 |
| 1679804892 | Amy Kathleenn Gaspar | Specialist/Technologist, Other | 4113 Pendleton Rd, Portsmouth, VA 23703 | 2010-01-28 |
| Find all providers in zip 23703 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962821967 | Jody Manners | Psychiatry & Neurology | 620 John Paul Jones Cir # 2e, Portsmouth, VA 23708 | 2014-04-08 |
| 1225343742 | Karen P. Lauze, LLC | Psychiatry & Neurology | 875 Greenland Rd Suite B4, Portsmouth, NH 03801 | 2010-08-09 |
| 1093998676 | Randy Kozel Md | Psychiatry & Neurology | 112 Clock Tower Sq, Portsmouth, RI 02871-1396 | 2007-12-06 |
| 1619178621 | Angela Rackley | Psychiatry & Neurology | 1711 27th St Ste 103a, Portsmouth, OH 45662-2654 | 2007-05-29 |
| 1043269434 | Augusto C Juguilon | Psychiatry & Neurology | 1711 27th St # 103a, Portsmouth, OH 45662-2654 | 2006-05-10 |
| 1376539098 | Patricia A Locuratolo | Psychiatry & Neurology | 875 Greenland Rd, Suite B4-5, Portsmouth, NH 03801-4164 | 2005-09-27 |
| 1699775486 | Randy B Kozel | Psychiatry & Neurology | 112 Clock Tower Square, Portsmouth, RI 02871-1365 | 2005-07-22 |
| 1598762551 | Grace A. Medeiros | Psychiatry & Neurology | 2444 E Main Rd, Portsmouth, RI 02871-4025 | 2005-07-06 |
| 1396199105 | Stephen Nnodim Jr. | Psychiatry & Neurology | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2016-04-18 |
| 1740675503 | Sarah Emily Woodson Smith | Psychiatry & Neurology | 620 John Paul Jones Cir, Portsmouth, VA 23708-2111 | 2015-03-30 |
| Find all providers in PORTSMOUTH | ||||
| City | PORTSMOUTH |
| Zip Code | 23703 |
Please comment or provide details below to improve the information on TIDEWATER NEUROLOGISTS INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.