Provider Demographics
NPI:1598891830
Name:KIDNEY AND MEDICAL SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:KIDNEY AND MEDICAL SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:N
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SANTACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-588-1100
Mailing Address - Street 1:7428 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3815
Mailing Address - Country:US
Mailing Address - Phone:757-588-1100
Mailing Address - Fax:
Practice Address - Street 1:7428 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3815
Practice Address - Country:US
Practice Address - Phone:757-588-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028564174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010370990Medicaid
VA010370990Medicaid
VAB09939Medicare UPIN