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General NPI Number Information
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NPI Number | 1316904501
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Entity Type | Individual
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Provider Name | MR. MICHAEL RAY STITH JR.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 11/07/2008
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Provider Practice Location Address
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Address Line | COMMANDANT U S COAST GUARD 2100 2ND STREET SW, SUITE 5314
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City | WASHINGTON
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State | DC
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Zip | 20593-0001
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Country | US
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Telephone | 410-636-7506
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Fax | 410-636-7868
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Provider Business Mailing Address
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Address Line | COMMANDANT U S COAST GUARD 2100 2ND STREET SW, SUITE 5314
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City | WASHINGTON
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State | DC
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Zip | 20593-0001
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Country | US
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Telephone | 410-636-7506
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Fax | 410-636-7868
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number | 24720000X
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License Number State | VA
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