Provider Demographics
NPI:1700938750
Name:PULMONARY CONSULTANTS OF TIDEWATER PC
Entity Type:Organization
Organization Name:PULMONARY CONSULTANTS OF TIDEWATER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-547-9451
Mailing Address - Street 1:113 GAINSBOROUGH SQ
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1713
Mailing Address - Country:US
Mailing Address - Phone:757-547-9451
Mailing Address - Fax:757-547-1405
Practice Address - Street 1:113 GAINSBOROUGH SQ
Practice Address - Street 2:SUITE 300
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1713
Practice Address - Country:US
Practice Address - Phone:757-547-9451
Practice Address - Fax:757-547-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031986207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACA6719OtherRAILROAD MEDICARE
VA149069300OtherOWCP
VA042676OtherANTHEM
NC8902473Medicaid
NC02473OtherBLUE CROSS AND BLUE SHIEL
VA149069300OtherOWCP