Provider Demographics
NPI:1215591888
Name:GALVAN, NASH RICHARD (IDC)
Entity Type:Individual
Prefix:MR
First Name:NASH
Middle Name:RICHARD
Last Name:GALVAN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS STOUT (DDG 55 )
Mailing Address - Street 2:UNIT 100290, BOX 1
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09587-1273
Mailing Address - Country:US
Mailing Address - Phone:757-444-8814
Mailing Address - Fax:
Practice Address - Street 1:456-462 POCAHONTAS ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511
Practice Address - Country:US
Practice Address - Phone:757-445-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD8173074OtherDRIVER'S LICENSE