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General NPI Number Information
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NPI Number | 1932460086
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Entity Type | Organization
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Legal Business Name | USN
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 159 CHARTER OAK DR
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City | GROTON
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State | CT
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Zip | 06340-2908
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Country | US
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Telephone | 904-214-6030
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Fax |
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Provider Business Mailing Address
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Address Line | 159 CHARTER OAK DR
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City | GROTON
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State | CT
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Zip | 06340-2908
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Country | US
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Telephone | 904-214-6030
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Fax |
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Authorized Official
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Title or Position | SUBMARINE
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Name | SUSANO MICHEL SILVA
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Credential | IDC
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Telephone | 904-214-6030
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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 |
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License Number State |
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