| NPI | 1053558981 |
|---|---|
| Doing Business As | TIDEWATER MEDICAL CARE PC |
| Entity Type | Organization |
| Authorized Contact | MIGDONIA MONTEJO Owner/President 757-965-9465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101058505) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2010-02-03 |