Long Term Care of Tidewater PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LONG TERM CARE OF TIDEWATER PC

Practice address

6160 Kempsville Cir Ste 325a
Norfolk, VA 23502-3933

Phone

(757) 917-5356

Fax

(757) 917-5141

NPI assigned

Jun 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jayne Walter

Title

Credentialing

Phone

(757) 917-5356

Specialties & licenses 5

Addresses

Other identifiers 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles G Maresh, MD

  • Internal Medicine Physician
  • Kilmarnock, VA
  • NPI 1669452090
  NPD (past)
• Angela Denise McFadden, FNP

  • Family Nurse Practitioner
  • Chesapeake, VA
  • NPI 1245287614
  NPD (past)
• Janet A Schutt, ANP

  • Adult Health Nurse Practitioner
  • Norfolk, VA
  • NPI 1831179555
  NPD (past)
• Hamid R Tavakoli, MD

  • Psychiatry Physician
  • Portsmouth, VA
  • NPI 1346276490
  NPD (past)
• Stephanie C Grimaldi, PA-C

  • Physician Assistant
  • New Haven, CT
  • NPI 1730149022
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572566400000",
    "number": "1033154430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 KINGSLEY LN STE 312",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054618",
            "telephone_number": "757-917-5356",
            "fax_number": "757-917-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6160 KEMPSVILLE CIR STE 325A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023933",
            "telephone_number": "757-917-5356",
            "fax_number": "757-917-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG TERM CARE OF TIDEWATER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2019-11-01",
        "status": "A",
        "authorized_official_last_name": "WALTER",
        "authorized_official_first_name": "JAYNE",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "757-917-5356"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CK3562",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Joyce Lomax, NNP
• Michael Lake Lomax, DO
• Lynzee Lombard, CSA
• Deborah J London, RPH MBA
• Long Journey Counseling, LLC
• Darelle Yvette Long
• Genevieve Long, LCSW
• Kyle David Long, PA-C
• Mark A D Long, ED.D.
• Paige Long

• Internal Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.