Provider Demographics
NPI:1386844389
Name:MILES, SEAN PATRICK (USN IDC)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PATRICK
Last Name:MILES
Suffix:
Gender:M
Credentials:USN IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 SCHOFIELD RD
Mailing Address - Street 2:
Mailing Address - City:VIRGININA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-2845
Mailing Address - Country:US
Mailing Address - Phone:757-763-4050
Mailing Address - Fax:
Practice Address - Street 1:1636 REGULUS AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461
Practice Address - Country:US
Practice Address - Phone:757-893-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman