Provider Demographics
NPI:1932225299
Name:PORT WARWICK SURGERY, PLLC
Entity Type:Organization
Organization Name:PORT WARWICK SURGERY, PLLC
Other - Org Name:LIANIS Z. BIDOT MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANIS
Authorized Official - Middle Name:ZAHIRA
Authorized Official - Last Name:BIDOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-873-0050
Mailing Address - Street 1:11803 JEFFERSON AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2565
Mailing Address - Country:US
Mailing Address - Phone:757-873-0050
Mailing Address - Fax:757-873-1448
Practice Address - Street 1:11803 JEFFERSON AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2565
Practice Address - Country:US
Practice Address - Phone:757-873-0050
Practice Address - Fax:757-873-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7302398Medicaid
VA7302398Medicaid