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INTEGRATED DERMATOLOGY OF TIDEWATER LLC
NPI 1801238472
Dermatology in Norfolk, VA

Active since July 24, 2013CLIA 49D2080708 · Certificate of Compliance
885 KEMPSVILLE RD STE 309, NORFOLK, VA 23502(757) 461-1033 Get Directions Write a Review

NPPES record last updated: January 29, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Integrated Dermatology Of Tidewater Llc NPPES

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

INTEGRATED DERMATOLOGY OF TIDEWATER LLC (NPI 1801238472) is a healthcare organization registered as a dermatology in Norfolk, Virginia and active in the NPI registry since July 2013. The organization holds a CLIA Certificate of Compliance certificate valid through January 6, 2027 and lists Jeffrey D Queen, Owner, as its authorized official.

NPPES Registry Identity

NPI1801238472
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameINTEGRATED DERMATOLOGY OF TIDEWATER LLC
Location Address885 KEMPSVILLE RD STE 309Norfolk, VA 23502-3800
Mailing Address4700 Exchange Ct Ste 110Boca Raton, FL 33431-4450 · (561) 314-2000
Phone(757) 461-1033
Organization SubpartNo
Authorized OfficialJeffrey D QueenOwner · (514) 314-2000
Enumeration DateJuly 24, 2013
Last NPPES UpdateJanuary 29, 2019
✔ NPI 1801238472 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
885 KEMPSVILLE RD STE 309, Norfolk, VA 23502
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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Integrated Dermatology Of Tidewater Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Integrated Dermatology Of Tidewater LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Bruce Fuller, M.D.
Dermatology
NPI 1538117890
885 KEMPSVILLE RD STE 309
Norfolk, VA 23502
(757) 347-2712
✔ PECOS✔ Accepts MedicareSame address
Elizabeth Gibson, NP
Nurse Practitioner
NPI 1649012303
885 KEMPSVILLE RD STE 309
Norfolk, VA 23502
(757) 347-2712
✔ PECOS✔ Accepts MedicareSame address
John Roman, M.D.
Dermatology
NPI 1700148277
885 KEMPSVILLE RD STE 309
Norfolk, VA 23502
(757) 347-2712
✔ PECOS✔ Accepts MedicareSame address
Jonathan Schreiber, MD
Dermatology
NPI 1689785578
885 KEMPSVILLE RD STE 309
Norfolk, VA 23502
(757) 347-2712
✔ PECOS✔ Accepts MedicareSame address
Anis Miladi, M.D.
Dermatology
NPI 1003879495
620 JOHN PAUL JONES CIR
Portsmouth, VA 23708
(757) 953-0311
✔ PECOS✔ Accepts Medicare6.2 mi
Wasim Haidari, MD
Dermatology
NPI 1376172056
1940 STONEGATE DR STE 130
Vestavia Hls, AL 35242
(205) 977-9876
✔ PECOS✔ Accepts Medicare638 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 49D2080708

Integrated Dermatology Of Tidewater-Norfolk · Norfolk, VA
Active · expires Jan 6, 2027
CLIA Number49D2080708
Laboratory TypePhysician Office
Certificate Effective DateJanuary 7, 2025
Certificate Expiration DateJanuary 6, 2027
Laboratory DirectorJonathan L. Schreiber
Laboratory Phone(757) 461-1033
Laboratory LocationIntegrated Dermatology Of Tidewater-Norfolk885 Kempsville Road - Suite 309, Norfolk, VA 23502
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Integrated Dermatology Of Tidewater LLC's NPI number?

The NPI number for Integrated Dermatology Of Tidewater LLC is 1801238472. It was assigned to this organization in the NPPES registry on July 24, 2013.

Where is Integrated Dermatology Of Tidewater LLC located?

Integrated Dermatology Of Tidewater LLC is located at 885 Kempsville Rd Ste 309, Norfolk, VA 23502. The listed phone number is (757) 461-1033.

What is Integrated Dermatology Of Tidewater LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Integrated Dermatology Of Tidewater LLC enrolled in Medicare?

Yes. Integrated Dermatology Of Tidewater LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Integrated Dermatology Of Tidewater LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Integrated Dermatology Of Tidewater LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (5) and Nurse Practitioner (1). Of these, 4 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Integrated Dermatology Of Tidewater LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 49D2080708) is associated with this NPI, valid through January 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Integrated Dermatology Of Tidewater LLC was last updated on January 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.