Provider Demographics
NPI:1518990423
Name:NEPHROLOGY ASSOCIATES OF TIDEWATER LTD
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF TIDEWATER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-466-9288
Mailing Address - Street 1:6160 KEMPSVILLE CIRCLE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3936
Mailing Address - Country:US
Mailing Address - Phone:757-466-9288
Mailing Address - Fax:757-457-3691
Practice Address - Street 1:6160 KEMPSVILLE CIRCLE
Practice Address - Street 2:SUITE 302A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3936
Practice Address - Country:US
Practice Address - Phone:757-466-9288
Practice Address - Fax:757-457-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003945OtherANTHEM
CL1384OtherRAILROAD MEDICARE
CL1384OtherRAILROAD MEDICARE