Provider Demographics
NPI:1891769840
Name:NAVAL MEDICAL CENTER PORTSMOUTH
Entity Type:Organization
Organization Name:NAVAL MEDICAL CENTER PORTSMOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY DEPARTMENT HEAD
Authorized Official - Prefix:
Authorized Official - First Name:LAWERANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LECLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-953-1128
Mailing Address - Street 1:3127 HARVESTTIME CRES
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5901
Mailing Address - Country:US
Mailing Address - Phone:757-484-0268
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CENTER POSRTSMOUTH
Practice Address - Street 2:620 JOHN PAUL JONES CIR
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2197
Practice Address - Country:US
Practice Address - Phone:757-953-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37611286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital