NPIMap

Organization Active NPI

Colon Rectal Surgery of Tidewater, P.C.

  • Colon & Rectal Surgery Physician
  • Portsmouth, VA
National Provider Identifier
1790794022
Registry record updated Sep 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
0101031444 Issued in 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
Last updated
Sep 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2011

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

Authorized official

Name
Dr. Jeffrey Stephen Wolf, M.D.NPI 1083731525
Title
President
Phone
(757) 484-9653

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
Colon & Rectal Surgery Physician 208C00000X 0101031444 VA Primary

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 5

IdentifierTypeStateIssuer
292832OtherVAMAMSI
890528EMedicaidNC
200136OtherVAOPTIMA
005841232MedicaidVA
072337OtherVABC/BS

National Provider Directory

National Provider Directory

Locations

667 Kingsborough Sq
Ste 101
Chesapeake, VA 23320
Phone (757) 312-3132

3235 Academy Ave
Ste 200
Portsmouth, VA 23703
Phone (757) 397-7858

Practitioners & affiliated clinicians

Practitioners 107

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.

View all 107

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315958400000",
    "number": "1790794022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3235 ACADEMY AVE",
            "address_2": "SUITE 100",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033200",
            "telephone_number": "757-484-9653",
            "fax_number": "757-484-9662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3235 ACADEMY AVE",
            "address_2": "SUITE 100",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237033200",
            "telephone_number": "757-484-9653",
            "fax_number": "757-484-9662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLON RECTAL SURGERY OF TIDEWATER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2011-09-14",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-484-9653",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "VA",
            "license": "0101031444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "292832",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890528E",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA",
            "identifier": "200136",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005841232",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "072337",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.