COLON RECTAL SURGERY OF TIDEWATER, P.C.
NPI 1790794022
Colon & Rectal Surgery in Portsmouth, VA

Q: What is Colon Rectal Surgery Of Tidewater, P.C.'s specialty?

The primary specialty registered for this NPI is Colon & Rectal Surgery with taxonomy code 208C00000X.

Active since August 05, 2006

3235 ACADEMY AVE, SUITE 100, PORTSMOUTH, VA 23703(757) 484-9653(757) 484-9662 Get Directions Write a Review

NPPES record last updated: September 14, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Colon Rectal Surgery Of Tidewater, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COLON RECTAL SURGERY OF TIDEWATER, P.C. (NPI 1790794022) is a healthcare organization registered as a colon & rectal surgery in Portsmouth, Virginia and active in the NPI registry since August 2006. The organization lists Jeffrey Stephen Wolf, President, as its authorized official.

NPPES Registry Identity

NPI1790794022

Entity TypeOrganization

Primary Taxonomy208C00000X

Legal Business NameCOLON RECTAL SURGERY OF TIDEWATER, P.C.

Location Address3235 ACADEMY AVE, SUITE 100Portsmouth, VA 23703-3200

Mailing Address3235 Academy Ave, Suite 100Portsmouth, VA 23703-3200 · (757) 484-9653 · Fax (757) 484-9662

Phone(757) 484-9653

Fax(757) 484-9662

Organization SubpartNo

Authorized OfficialJeffrey Stephen WolfPresident · (757) 484-9653

Enumeration DateAugust 5, 2006

Last NPPES UpdateSeptember 14, 2011

✔ NPI 1790794022 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyColon & Rectal SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208C00000X

License✔ Licensed in VA · 0101031444

Definition

A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease.

3235 ACADEMY AVE, Portsmouth, VA 23703

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Other Identifiers 9

Medicare ID-Type Unspecified00V712C97VA

Medicare ID-Type Unspecified280000251VA · Medicare Railroad

Other200136VA · Optima

Medicare PIN2317306NC

Medicare UPINB07424VA

Other072337VA · Bc/bs

Other292832VA · Mamsi

Medicaid890528ENC

Medicaid005841232VA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FLORDELIZA ABLAO-CHANTHAVICHITH N.P.

Nurse Practitioner

3235 ACADEMY AVE, SUITE 305
PORTSMOUTH, VA 23703

Portsmouth City (757) 686-9300

DR. JEFFREY STEPHEN WOLF M.D.

Colon & Rectal Surgery

3235 ACADEMY AVE, SUITE 200
PORTSMOUTH, VA 23703

Portsmouth City (757) 484-9653

MARY ALISON MERCER OD

Optometrist

3235 ACADEMY AVE, SUITE 200
PORTSMOUTH, VA 23703

Portsmouth City (757) 483-0400

DR. MARTIN PAUL HARPEN MD

Internal Medicine (Nephrology)

3235 ACADEMY AVE, STE 301
PORTSMOUTH, VA 23703

Portsmouth City (757) 484-9400

ROGER W NEWSOM MD

Ophthalmology (Ophthalmic Plastic and Reconstructive Surgery)

3235 ACADEMY AVE, SUITE 200
PORTSMOUTH, VA 23703

Portsmouth City (757) 483-0400

JOHN T EDMONDS MD

Ophthalmology

3235 ACADEMY AVE, SUITE 200
PORTSMOUTH, VA 23703

Portsmouth City (757) 483-0400

KRUNAL MANUBHAI PATEL MD

Internal Medicine (Nephrology)

3235 ACADEMY AVE, SUITE 301
PORTSMOUTH, VA 23703

Portsmouth City (757) 484-9400

MARK A PAVILACK MD

Ophthalmology

3235 ACADEMY AVE, SUITE 200
PORTSMOUTH, VA 23703

Portsmouth City (757) 483-0400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Colon Rectal Surgery Of Tidewater, P.C.'s NPI number?

The NPI number for Colon Rectal Surgery Of Tidewater, P.C. is 1790794022. It was assigned to this organization in the NPPES registry on August 5, 2006.

Where is Colon Rectal Surgery Of Tidewater, P.C. located?

Colon Rectal Surgery Of Tidewater, P.C. is located at 3235 Academy Ave Suite 100, Portsmouth, VA 23703. The listed phone number is (757) 484-9653.

What is Colon Rectal Surgery Of Tidewater, P.C.'s specialty?

The primary specialty registered for this NPI is Colon & Rectal Surgery with taxonomy code 208C00000X.

When was this NPI record last updated?

The NPPES record for Colon Rectal Surgery Of Tidewater, P.C. was last updated on September 14, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.