NPIMap

Organization Active NPI

Tidewater Ped. Consultants, PC

  • Pediatrics Physician
  • Virginia Beach, VA
National Provider Identifier
1841298759
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
002500-8011 Issued in VA
Legal business name
TIDEWATER PED. CONSULTANTS, PC
Practice address
6477 College Park SQ
Ste 118
Virginia Beach, VA 23464-3611
Phone
(757) 420-6218
Fax
(757) 420-0487
NPI assigned
Jul 13, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Rosetta S Cherry, LPN
Title
Practice Manager
Phone
(757) 420-0487

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 002500-8011 VA Primary

Addresses

Primary practice location

6477 College Park SQ
Ste 118
Virginia Beach, VA 23464-3611

Mailing address

6477 College Park SQ
Ste 118
Virginia Beach, VA 23464-3611
Phone (757) 420-6218

National Provider Directory

National Provider Directory

Locations

1682 Church St
Ste 118
Norfolk, VA 23504

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2533/brand/1/csg/1/fhir/r4

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": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841298759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6477 COLLEGE PARK SQ",
            "address_2": "STE 118",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234643611",
            "telephone_number": "757-420-6218",
            "fax_number": "757-420-0487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6477 COLLEGE PARK SQ",
            "address_2": "STE 118",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234643611",
            "telephone_number": "757-420-6218",
            "fax_number": "757-420-0487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER PED. CONSULTANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHERRY",
        "authorized_official_first_name": "ROSETTA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "757-420-0487",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "002500-8011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.