Tidewater Medical Clinic PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101055402 Issued in VA

Legal business name

TIDEWATER MEDICAL CLINIC PC

Practice address

111 Coastal Way
Chesapeake, VA 23320-4603

Phone

(757) 549-9671

Fax

(757) 549-6802

NPI assigned

Mar 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Luis G. Carpio, M.D.

Title

President

Phone

(757) 549-9671

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

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

• Madhukar Kaloji, M.D.

  • Pulmonary Disease Physician
  • Virginia Beach, VA
  • NPI 1306856133
  NPD (past)

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467579482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COASTAL WAY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204603",
            "telephone_number": "757-549-9671",
            "fax_number": "757-549-6802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COASTAL WAY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204603",
            "telephone_number": "757-549-9671",
            "fax_number": "757-549-6802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARPIO",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-549-9671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101055402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tidewater Endocrinology LLC
• Tidewater Family Medical Care, PC
• Tidewater Healthcare Services, Inc
• Tidewater Home Modifiers LLC
• Tidewater Internal Medicine and Hypertension Center. PLC
• Tidewater Medical Supply, Inc
• Tidewater Physical Therapy, Inc.
• Tidewater Physical Therapy, LLC
• Tidewater Physical Therapy, LLC
• Tidewater Surgical

• Internal Medicine Physician in Chesapeake, VA
• Providers in Chesapeake, 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.