Healthcare Provider Details

I. General information

NPI: 1073603304
Provider Name (Legal Business Name): NAVAL HEALTH CLINIC NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE BUILDING 449
GROTON CT
06349-2324
US

IV. Provider business mailing address

NAVAL BRANCH HEALTH CLINIC GROTON 1 WAHOO AVE
GROTON CT
06349
US

V. Phone/Fax

Practice location:
  • Phone: 888-628-9633
  • Fax: 860-694-2367
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA POSC
Credential:
Phone: 210-536-6650