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General NPI Number Information
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NPI Number | 1578548699
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Entity Type | Organization
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Legal Business Name | UNITED STATES COAST GUARD
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15 MOHEGAN AVE
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City | NEW LONDON
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State | CT
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Zip | 06320-8100
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Country | US
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Telephone | 860-444-8402
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Fax | 860-444-8413
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Provider Business Mailing Address
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Address Line | 22 MONROE LN
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City | GROTON
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State | CT
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Zip | 06340-2434
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Country | US
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Telephone | 860-449-0681
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Fax |
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Authorized Official
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Title or Position | HEALTH SERVICES TECHNICAN
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Name | MRS. MARIA INEZ DICKINSON
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Credential |
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Telephone | 860-449-0681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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