Healthcare Provider Details

I. General information

NPI: 1437508355
Provider Name (Legal Business Name): RICHARD DEAN NEADING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2D RAIDER BATTALION PSC BOX 20183
CAMP LEJEUNE NC
28542
US

IV. Provider business mailing address

106 LOIS CT
RICHLANDS NC
28574
US

V. Phone/Fax

Practice location:
  • Phone: 910-440-7704
  • Fax:
Mailing address:
  • Phone: 330-323-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: