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General NPI Number Information
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NPI Number | 1891769840
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Entity Type | Organization
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Legal Business Name | NAVAL MEDICAL CENTER PORTSMOUTH
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | NAVAL MEDICAL CENTER POSRTSMOUTH 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2197
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Country | US
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Telephone | 757-953-7297
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Fax |
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Provider Business Mailing Address
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Address Line | 3127 HARVESTTIME CRES
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5901
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Country | US
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Telephone | 757-484-0268
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Fax |
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Authorized Official
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Title or Position | RADIOLOGY DEPARTMENT HEAD
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Name | LAWERANCE LECLAIR
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Credential | MD
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Telephone | 757-953-1128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 37611
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License Number State | WI
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