Provider Demographics
NPI:1255632998
Name:VANCLEAVE, JAMES P (SFIDC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:VANCLEAVE
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 BLACKHAWK CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323
Mailing Address - Country:US
Mailing Address - Phone:757-966-5006
Mailing Address - Fax:
Practice Address - Street 1:USS OAK HILL
Practice Address - Street 2:(LSD 51)
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09573-1735
Practice Address - Country:US
Practice Address - Phone:757-462-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman