Tidewater Endocrine Consultants, PC

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

0101229098 Issued in VA

Legal business name

TIDEWATER ENDOCRINE CONSULTANTS, PC

Practice address

667 Kingsborough SQ
Suite 300
Chesapeake, VA 23320-4999

Phone

(757) 436-0909

Fax

(757) 436-0168

NPI assigned

Mar 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Dwight Fitzgerald Matthias, MDNPI 1609805332

Title

President

Phone

(757) 436-0909

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.

• Dwight Fitzgerald Matthias, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Newport News, VA
  • NPI 1609805332

  Endocrinology, Diabetes & Metabolism, VA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811028152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1345",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233271345",
            "telephone_number": "757-436-0909",
            "fax_number": "757-436-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 KINGSBOROUGH SQ",
            "address_2": "SUITE 300",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204999",
            "telephone_number": "757-436-0909",
            "fax_number": "757-436-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER ENDOCRINE CONSULTANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATTHIAS",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "FITZGERALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-436-0909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "VA",
            "license": "0101229098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• All providers in Chesapeake, VA
• Endocrinology, Diabetes & Metabolism 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.