Provider Demographics
NPI:1609814995
Name:WRIGHT, WESTON RAYTH (IDC)
Entity Type:Individual
Prefix:MR
First Name:WESTON
Middle Name:RAYTH
Last Name:WRIGHT
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 1:701 MILBY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-5030
Mailing Address - Country:US
Mailing Address - Phone:757-420-2243
Mailing Address - Fax:
Practice Address - Street 1:USS GEORGE WASHINGTON CVN-73
Practice Address - Street 2:BOX 67
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09550-2873
Practice Address - Country:US
Practice Address - Phone:757-420-2243
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman