Provider Demographics
NPI:1851301105
Name:WRIGHT, EMMANUEL
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAMEDDAC BAMBERG UNIT 27535
Mailing Address - Street 2:ATTN: CREDENTIAL OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09139
Mailing Address - Country:US
Mailing Address - Phone:0951-300-8677
Mailing Address - Fax:
Practice Address - Street 1:USAMEDDAC BAMBERG UNIT 27535
Practice Address - Street 2:ATTN: CREDENTIAL OFFICE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139
Practice Address - Country:US
Practice Address - Phone:0951-300-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOOOMedicare UPIN