Provider Demographics
NPI:1114403961
Name:NAVAL MEDICAL CENTER PORTSMOUTH
Entity Type:Organization
Organization Name:NAVAL MEDICAL CENTER PORTSMOUTH
Other - Org Name:DOD PORTS VA TPC SUFFOLK EPHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:7021 HARBOR VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2869
Mailing Address - Country:US
Mailing Address - Phone:757-953-4981
Mailing Address - Fax:757-953-5025
Practice Address - Street 1:7021 HARBOR VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2869
Practice Address - Country:US
Practice Address - Phone:757-953-4981
Practice Address - Fax:757-953-5025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL MEDICAL CENTER PORTSMOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-16
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy