| Tidewater Medical Clinic Pc | |
|
111 Coastal Way Chesapeake VA 23320-4603 | |
| (757) 549-9671 | |
| (757) 549-6802 |
| Full Name | Tidewater Medical Clinic Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 111 Coastal Way, Chesapeake, Virginia |
| Authorized Official Name and Position | Luis G. Carpio (PRESIDENT) |
| Authorized Official Contact | 7575499671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Medical Clinic Pc 111 Coastal Way Chesapeake VA 23320-4603 Ph: (757) 549-9671 | Tidewater Medical Clinic Pc 111 Coastal Way Chesapeake VA 23320-4603 Ph: (757) 549-9671 |
| NPI Number | 1467579482 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9537283932 |
|---|---|
| Medicare Enrollment ID | O20100907000573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467579482 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0101055402 (Virginia) | Primary |
| Provider Name | Luis G Carpio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518919695 PECOS PAC ID: 8527182922 Enrollment ID: I20100907000681 |
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