MEDICARE: JUSTIN WOLFE HORSCHEL USCG IDHS

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	:	1679430540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN WOLFE HORSCHEL USCG IDHS

Provider Business Mailing Address
First Line	:	3823 MAIN ST
Second Line	:
City	:	CHINCOTEAGUE
State	:	VA
Zip	:	23336-1857
Country	:	US
Telephone Number	:	254-423-2767
Fax Number	:

Provider Business Practice Location Address
First Line	:	3823 MAIN ST
Second Line	:
City	:	CHINCOTEAGUE
State	:	VA
Zip	:	23336-1857
Country	:	US
Telephone Number	:	254-423-2767
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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