OrganizationTidewater Pediatrics, P.C.PediatricsAllopathic & Osteopathic PhysiciansPractice Address301 Goode Way Ste 203, Portsmouth, VA 23704-2266(757) 399-5300PECOS EnrollmentBased on the most recent information from CMS, provider Tidewater Pediatrics, P.C. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1134685050Provider TypeOrganizationFull NameTidewater Pediatrics, P.C.SubpartNoEnumeration Date2/15/2019Last Updated2/15/2019Contact InformationPractice LocationPractice Address301 Goode Way Ste 203, Portsmouth, VA 23704-2266Phone(757) 399-5300FaxUnlisted FaxMailing LocationMailing Address301 Goode Way Ste 203, Portsmouth, VA 23704-2266Phone(757) 399-5300Fax(757) 399-5987Authorized OfficialNameBibay, Laarni Serquina (President)Phone(757) 399-5300Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1841206166DescriptionMedicaidIssuerUnlistedVirginia