| Tidewater Medical Care Pc | |
|
4608 Thoroughgood Drive Virginia Beach VA 23455 | |
| (757) 965-9465 | |
| (757) 965-9491 |
| Full Name | Tidewater Medical Care Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 4608 Thoroughgood Drive, Virginia Beach, Virginia |
| Authorized Official Name and Position | Migdonia Montejo (OWNER/PRESIDENT) |
| Authorized Official Contact | 7579659465 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Medical Care Pc 4608 Thoroughgood Drive Virginia Beach VA 23455 Ph: (757) 965-9465 | Tidewater Medical Care Pc 4608 Thoroughgood Drive Virginia Beach VA 23455 Ph: (757) 965-9465 |
| NPI Number | 1053558981 |
|---|---|
| Provider Enumeration Date | 01/14/2009 |
| Last Update Date | 02/03/2010 |
| Medicare PECOS PAC ID | 9133271661 |
|---|---|
| Medicare Enrollment ID | O20090715000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053558981 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101058505 (Virginia) | Primary |
| Provider Name | Judi Griffin |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1275506123 PECOS PAC ID: 8022084185 Enrollment ID: I20040909000489 |
| Provider Name | Baher Anwar Basta |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1538130257 PECOS PAC ID: 6305878372 Enrollment ID: I20050910000074 |
| Provider Name | Migdonia Montejo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467459347 PECOS PAC ID: 2062593080 Enrollment ID: I20080116000376 |
| Provider Name | Tammy Jo Maloney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689617102 PECOS PAC ID: 0749345379 Enrollment ID: I20090216000368 |
| Provider Name | Jorge M Zarate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962409193 PECOS PAC ID: 4486706918 Enrollment ID: I20090715000084 |
| Provider Name | Robert C Cajes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073776027 PECOS PAC ID: 2264619212 Enrollment ID: I20110531000756 |
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