| Family Physicians Of Tidewater Pllc | |
|
110 Kingsley Ln Suite 202 Norfolk VA 23505-4614 | |
| (757) 889-6520 | |
| (757) 489-4905 |
| Full Name | Family Physicians Of Tidewater Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 110 Kingsley Ln, Norfolk, Virginia |
| Authorized Official Name and Position | Clement Stokes Kirkland (PRESIDENT) |
| Authorized Official Contact | 7578896520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Physicians Of Tidewater Pllc 110 Kingsley Ln Suite 202 Norfolk VA 23505-4614 Ph: (757) 889-6520 | Family Physicians Of Tidewater Pllc 110 Kingsley Ln Suite 202 Norfolk VA 23505-4614 Ph: (757) 889-6520 |
| NPI Number | 1790830826 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4183813975 |
|---|---|
| Medicare Enrollment ID | O20110110000496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790830826 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Clement S Kirkland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437205234 PECOS PAC ID: 1153510946 Enrollment ID: I20110110000546 |
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