MINIMALLY INVASIVE SURGERY CENTER OF TIDEWATER (NPI# 1861728461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861728461 |
| Entity Type | Organization |
| Organization Name | MINIMALLY INVASIVE SURGERY CENTER OF TIDEWATER |
| Practice Address |
160 Kingsley Ln Suite 205 Norfolk VA 23505-4600 |
| Practice Telephone | 7578896680 |
| Practice Fax Number | 7578896686 |
| Mailing Telephone | 7578896680 |
| Mailing Fax Number | 7578896686 |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2009-12-22 |
| Authorized Official Name | DR. ROBERT C KNOWLES (GENERAL SURGEON) |
| Authorized Official Telephone | 7578896680 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 0101058403 | VA | Allopathic & Osteopathic Physicians |
| Street Address |
160 KINGSLEY LN SUITE 205 |
| City | NORFOLK |
| State | VA |
| Zip Code | 23505-4600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891791521 | Glaucoma Laser Center PC | Ophthalmology | 160 Kingsley Ln, Ste 300, Norfolk, VA 23505-4600 | 2005-06-27 |
| 1861022840 | Barbara Lenette Mccray | Nurse Practitioner | 160 Kingsley Ln, Norfolk, VA 23505-4600 | 2020-01-18 |
| 1245524776 | Kamilla A Shall | Physician Assistant | 160 Kingsley Ln, Suite 400, Norfolk, VA 23505-4600 | 2011-06-01 |
| 1548415672 | Pedro D Hasas, Md, Plc | Internal Medicine | 160 Kingsley Ln, Suite# 205, Norfolk, VA 23505-4600 | 2008-11-17 |
| 1538378708 | Sharpe and Associates, P.C. | Dermatology | 160 Kingsley Ln, 504 Depaul Atrium Bldg, Norfolk, VA 23505-4600 | 2007-05-22 |
| 1770613895 | Vann-virginia Center for Orthopaedics PC | Physical Therapist | 160 Kingsley Ln, Suite 405, Norfolk, VA 23505 | 2007-03-07 |
| 1184725806 | Virginia Annette Stewart | Surgery | 160 Kingsley Ln, Suite 400, Norfolk, VA 23505-4600 | 2006-09-26 |
| 1245330190 | Gilda Niknezhad | Nurse Practitioner | 160 Kingsley Ln, Suite 106, Norfolk, VA 23505-4600 | 2006-09-22 |
| 1457451437 | Carlos A. Silva | Internal Medicine | 160 Kingsley Ln, Suite 103, Norfolk, VA 23505-4600 | 2006-09-22 |
| 1679673685 | Manuela M Delacruz | Internal Medicine | 160 Kingsley Ln, Suite 103, Norfolk, VA 23505-4600 | 2006-09-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154844256 | Cassandra Shelton | Specialist/Technologist, Other | 100 Kingsley Lane, Norfolk, VA 23505 | 2017-07-20 |
| 1063942852 | Gabriela Marie Santiago | Specialist/Technologist | 7600 Victory Dr, Apt 3, Norfolk, VA 23505 | 2017-06-14 |
| 1144776725 | Amr Hassan | Pharmacist | 1610 W Little Creek Rd, Apt 204, Norfolk, VA 23505 | 2016-09-01 |
| 1992175095 | Heather Mitchell | Nurse Practitioner | 110 Kingsley Ln Ste 309, Norfolk, VA 23505 | 2015-10-01 |
| 1255710620 | Jessica Ann Kestranek | Dentist | 7400 Granby St Ste D, Norfolk, VA 23505 | 2015-05-19 |
| 1710375274 | Carla Toledo | Nurse Practitioner | 155 Kingsley Lane, Suite 400, Norfolk, VA 23505 | 2015-01-06 |
| 1417359746 | James Austin Valone Jr. | Ophthalmology | 1423 Runymede Rd, Norfolk, VA 23505 | 2014-09-18 |
| 1861813370 | Harris Teeter, LLC | Pharmacy | 7550 Granby Street, Norfolk, VA 23505 | 2013-12-31 |
| 1649549361 | Linda Horsey | Social Worker | 7510 Granby Street, Suite 6, Norfolk, VA 23505 | 2011-12-27 |
| 1679705164 | Carolyn Lee Kee | Nurse's Aide | 7403 Hampton Blvd, Norfolk, VA 23505 | 2009-08-17 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255728374 | Malinda Lyon | Surgery | 8150 Shore Drive, #522, Norfolk, VA 23518 | 2015-04-16 |
| 1336567601 | Ryan Carver | Surgery | 880 Kempsville Rd Ste 1000, Norfolk, VA 23502-3978 | 2014-04-02 |
| 1891052676 | Conor Francis Hynes | Surgery | 1530 Gilbert St Ste 2000, Norfolk, VA 23511 | 2012-04-18 |
| 1871867747 | Brian Joseph Kennerley | Surgery | U. S. Marine Corps Forces Command, 1775 Forrestal Drive Bldg 33, Norfolk, VA 23511 | 2012-02-23 |
| 1144590779 | Edward Albert Pollard | Surgery | 17 Lois Ln, Norfolk, MA 02056-1823 | 2012-01-12 |
| 1164683009 | Stephanie K Repole | Surgery | 155 Kingsley Ln Ste 405, Norfolk, VA 23505-4629 | 2008-06-23 |
| 1639277544 | Alan Harvey Jaffe | Surgery | 160 Kingsley Ln Ste 205, Norfolk, VA 23505-4600 | 2006-09-21 |
| 1437169042 | Venkat Manoranjan Reddy | Surgery | 400 Gresham Drive, Suite 308, Norfolk, VA 23507 | 2006-08-08 |
| 1114931938 | Thomas M Beutler | Surgery | 301 N 27th St, Suite 1, Norfolk, NE 68701-4457 | 2006-07-28 |
| 1699731901 | Andrew Y Reynolds | Surgery | 301 N 27th St Ste 8, Norfolk, NE 68701-4457 | 2006-04-25 |
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| 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.