MEDICARE: MR. REYNALDO AFABLE GALANG IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1215904206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REYNALDO AFABLE GALANG IDC

Provider Business Mailing Address
First Line	:	1056 HAWTHORNE FARM TER
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-6586
Country	:	US
Telephone Number	:	757-689-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1885 TERRIER AVE
Second Line	:	BRANCH HEALTH CLINIC DAM NECK STE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23461-2298
Country	:	US
Telephone Number	:	757-314-7215
Fax Number	:	757-314-7206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/08/2007

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