Organization · NPI-2

Tidewater Podiatry Group Ltd

Podiatrist, Foot & Ankle Surgery · Norfolk, VA

NPI number1356542922
StatusActive
Last updated in NPPESNov 7, 2013

Details

NPI
1356542922
Entity type
Organization (NPI-2)
Legal business name
Tidewater Podiatry Group Ltd
Organization subpart
No
Enumeration date
May 30, 2007
Last updated
Nov 7, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
213ES0103X Podiatrist, Foot & Ankle Surgery–VAYes

Practice location

6161 Kempsville Cir
Ste 230
Norfolk, VA 23502-3932

Phone 757-481-6248

Mailing address

6161 Kempsville Cir
Ste 230
Norfolk, VA 23502-3932

Phone 757-481-6248

Authorized official

Jay Tischler
President
7574816248

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