Provider Demographics
NPI:1295827079
Name:STEPHEN, JUSTIN MICHAEL (HEALTH SERVICE TECH)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:STEPHEN
Suffix:
Gender:M
Credentials:HEALTH SERVICE TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCG COMDT CG-1122 2100 2ND ST SW
Mailing Address - Street 2:SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:757-856-2230
Mailing Address - Fax:757-856-2276
Practice Address - Street 1:USCG COMDT CG-1122 2100 2ND ST SW
Practice Address - Street 2:SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:757-856-2230
Practice Address - Fax:757-856-2276
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other