Provider Demographics
NPI:1639949597
Name:MORROW, AUSTIN SHANE (SUBFOR IDC)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:SHANE
Last Name:MORROW
Suffix:
Gender:M
Credentials:SUBFOR IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 IRONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2528
Mailing Address - Country:US
Mailing Address - Phone:940-399-7090
Mailing Address - Fax:
Practice Address - Street 1:9 IRONWOOD LN
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2528
Practice Address - Country:US
Practice Address - Phone:940-399-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman