Provider Demographics
NPI:1740307099
Name:USCG SECTOR DELAWARE BAY
Entity type:Organization
Organization Name:USCG SECTOR DELAWARE BAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JIVONNE
Authorized Official - Middle Name:NIKELL
Authorized Official - Last Name:PRIOLEAU-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-271-4816
Mailing Address - Street 1:1 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4335
Mailing Address - Country:US
Mailing Address - Phone:215-271-4816
Mailing Address - Fax:215-271-4817
Practice Address - Street 1:1 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4335
Practice Address - Country:US
Practice Address - Phone:215-271-4816
Practice Address - Fax:215-271-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVAD000Medicare UPIN