Provider Demographics
NPI:1891338745
Name:GASTROINTESTINAL AND LIVER SPECIALISTS OF TIDEWATER PLLC
Entity Type:Organization
Organization Name:GASTROINTESTINAL AND LIVER SPECIALISTS OF TIDEWATER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-464-1644
Mailing Address - Street 1:1101 FIRST COLONIAL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2409
Mailing Address - Country:US
Mailing Address - Phone:757-481-4817
Mailing Address - Fax:757-481-7138
Practice Address - Street 1:1101 FIRST COLONIAL RD STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2409
Practice Address - Country:US
Practice Address - Phone:757-481-4817
Practice Address - Fax:757-481-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty