Provider Demographics
NPI:1548562259
Name:VANDALL, AARON BRENT (IDC-NAVY)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:BRENT
Last Name:VANDALL
Suffix:
Gender:M
Credentials:IDC-NAVY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 SILVERWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8024
Mailing Address - Country:US
Mailing Address - Phone:757-637-9379
Mailing Address - Fax:
Practice Address - Street 1:RIVRON 3, NWS YORKTOWN
Practice Address - Street 2:BLDG 686
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23691-1032
Practice Address - Country:US
Practice Address - Phone:757-637-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman