Provider Demographics
NPI:1891802765
Name:CARDIOVASCULAR PHYSICIANS OF TIDEWATER
Entity Type:Organization
Organization Name:CARDIOVASCULAR PHYSICIANS OF TIDEWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:COCHICHERIL
Authorized Official - Middle Name:NARAYAN
Authorized Official - Last Name:MONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-460-3400
Mailing Address - Street 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5500
Mailing Address - Country:US
Mailing Address - Phone:757-460-3400
Mailing Address - Fax:757-460-3444
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-460-3400
Practice Address - Fax:757-460-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6085164Medicaid
VA6085164Medicaid