Emergency Physician of Tidewater

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

0110001528 Issued in VA

Legal business name

EMERGENCY PHYSICIAN OF TIDEWATER

Practice address

4092 Foxwood Dr
Suite 101
Virginia Beach, VA 23462-5225

Phone

(757) 467-4200

Fax

(757) 467-4173

NPI assigned

Oct 6, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Aksel Keklik, PA-C

Title

Physician Assistant

Phone

(757) 410-8879

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851488167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 DOWNING DR",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233228703",
            "telephone_number": "757-410-8879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4092 FOXWOOD DR",
            "address_2": "SUITE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234625225",
            "telephone_number": "757-467-4200",
            "fax_number": "757-467-4173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY PHYSICIAN OF TIDEWATER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KEKLIK",
        "authorized_official_first_name": "AKSEL",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "757-410-8879",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "VA",
            "license": "0110001528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Acute Care Hospital in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• General Acute Care Hospital 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.