Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Colon Rectal Surgery of Tidewater, PC

Organization Colon & Rectal Surgery Physician · NPI 1790794022

Colon Rectal Surgery of Tidewater, PC is a Colon & Rectal Surgery Physician in Portsmouth, Virginia. Licensed in Virginia. Registered with an NPI since 2006.

Licensed in
VA
In the registry since
2006
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3235 Academy Ave Ste 100
Portsmouth, VA 23703-3200
Phone: (757) 484-9653
Fax: (757) 484-9662
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Colon & Rectal Surgery Physician (primary) Taxonomy 208C00000X · Licence 0101031444 (VA)

Record details

NPI number1790794022
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jeffrey Wolf — President · (757) 484-9653
NPI enumeratedAugust 5, 2006
Last updated in NPPESSeptember 14, 2011
Mailing address3235 Academy Ave, Suite 100, Portsmouth, VA 23703-3200

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