| Tidewater Endocrine Consultants, Pc | |
|
667 Kingsborough Sq Suite 300 Chesapeake VA 23320-4999 | |
| (757) 436-0909 | |
| (757) 436-0168 |
| Full Name | Tidewater Endocrine Consultants, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 667 Kingsborough Sq, Chesapeake, Virginia |
| Authorized Official Name and Position | Dwight Fitzgerald Matthias (PRESIDENT) |
| Authorized Official Contact | 7574360909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Endocrine Consultants, Pc Po Box 1345 Chesapeake VA 23327-1345 Ph: (757) 436-0909 | Tidewater Endocrine Consultants, Pc 667 Kingsborough Sq Suite 300 Chesapeake VA 23320-4999 Ph: (757) 436-0909 |
| NPI Number | 1811028152 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9234190364 |
|---|---|
| Medicare Enrollment ID | O20041022000148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811028152 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 0101229098 (Virginia) | Primary |
| Provider Name | Dwight F Matthias |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1609805332 PECOS PAC ID: 8123089257 Enrollment ID: I20041026000011 |
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