Provider Demographics
NPI:1912545534
Name:BURNETT, ASHTON NEAL (US NAVY IDC)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:NEAL
Last Name:BURNETT
Suffix:
Gender:M
Credentials:US NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 COVE RD BLDG 3806
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-8911
Mailing Address - Country:US
Mailing Address - Phone:757-763-2060
Mailing Address - Fax:
Practice Address - Street 1:1875 COVE RD BLDG 3806
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8911
Practice Address - Country:US
Practice Address - Phone:757-763-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman