Provider Demographics
NPI:1235417833
Name:TIDEWATER PATHOLOGY INC
Entity Type:Organization
Organization Name:TIDEWATER PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAVVAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENDRINOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-362-4051
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-0640
Mailing Address - Country:US
Mailing Address - Phone:973-751-7515
Mailing Address - Fax:973-751-1394
Practice Address - Street 1:924 EASTERN SHORE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3504
Practice Address - Country:US
Practice Address - Phone:757-362-4051
Practice Address - Fax:757-425-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-30
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory