Colon Rectal Surgery of Tidewater, P.C.
Organization Active NPI Colon & Rectal Surgery Physician · Portsmouth, VA
NPI 1790794022 · NPPES record last updated Sep 14, 2011
Key facts
- NPI
- 1790794022
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Colon & Rectal Surgery Physician 208C00000X
- License
- 0101031444 (VA)
- Legal business name
- COLON RECTAL SURGERY OF TIDEWATER, P.C.
- Practice address
- 3235 Academy Ave
Suite 100
Portsmouth, VA 23703-3200 - Phone
- (757) 484-9653
- Fax
- (757) 484-9662
- NPI assigned
- Aug 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey Stephen Wolf, M.D.
- Title
- President
- Phone
- (757) 484-9653
Practitioners 1
-
Jeffrey Stephen Wolf, M.D.
National Provider Directory
Locations
1301 Executive Blvd
#200
Chesapeake, VA 23320
Phone (757) 312-6460
3235 Academy Ave
Ste 100
Portsmouth, VA 23703
Phone (757) 484-0215
3235 Academy Ave
Portsmouth, VA 23703
Phone (804) 393-6582
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Colon & Rectal Surgery Physician |
208C00000X | 0101031444 | VA | Yes |
Addresses
Primary practice location
3235 Academy Ave
Suite 100
Portsmouth, VA 23703-3200
Mailing address
3235 Academy Ave
Suite 100
Portsmouth, VA 23703-3200
Phone (757) 484-9653
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005841232 | Medicaid | VA | |
| 072337 | Other | VA | BC/BS |
| 200136 | Other | VA | OPTIMA |
| 292832 | Other | VA | MAMSI |
| 890528E | Medicaid | NC |
Other providers in Portsmouth, VA
- Loice Moraa Collins
- Pamela L. Collins
- Sabrina Anita Collins
- Vinette Collins
- Ashlee Collister
- Gabriela Marie Colon
- Comfort Homes and Supported Living LLC
- Commonwealth Community Development Services Inc.
- Commonwealth Community Services LLC
- Commonwealth of Virginia State Board of Health
All providers in Portsmouth, VA · Colon & Rectal Surgery Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.