Provider Demographics
NPI:1538128350
Name:NAVAL HEALTH CLINIC NEW ENGLAND
Entity Type:Organization
Organization Name:NAVAL HEALTH CLINIC NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUMED UBO
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 1:43 SMITH RD
Mailing Address - Street 2:BUILDING 43, ROOM 1063
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 SMITH RD
Practice Address - Street 2:BUILDING 43, ROOM 1063
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841-1002
Practice Address - Country:US
Practice Address - Phone:401-841-2157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HEALTH CLINIC NEW ENGLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-21
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient