NPIMap

Organization Active NPI

Tidewater Dermatopathology Service, Inc

  • Clinical Medical Laboratory
  • Norfolk, VA
National Provider Identifier
1760572291
Registry record updated May 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
0101-027130 Issued in VA
Legal business name
TIDEWATER DERMATOPATHOLOGY SERVICE, INC
Practice address
601 Medical Tower
Norfolk, VA 23507
Phone
(757) 622-6315
NPI assigned
Oct 13, 2006
Last updated
May 16, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2011

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

Authorized official

Name
Robert J. Pariser, M.D.NPI 1235232539
Title
President
Phone
(757) 622-6315

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 0101-027130 VA Primary

Addresses

Primary practice location

601 Medical Tower
Norfolk, VA 23507

Mailing address

601 Medical Tower
Norfolk, VA 23507
Phone (757) 622-6315

Other identifiers 2

IdentifierTypeStateIssuer
4980662MedicaidVA
49D0229705OtherVACLIA ID NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305504000000",
    "number": "1760572291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEDICAL TOWER",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "23507",
            "telephone_number": "757-622-6315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 MEDICAL TOWER",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "23507",
            "telephone_number": "757-622-6315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER DERMATOPATHOLOGY SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2011-05-16",
        "status": "A",
        "authorized_official_last_name": "PARISER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-622-6315",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VA",
            "license": "0101-027130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4980662",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA ID NUMBER",
            "identifier": "49D0229705",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; 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.