Provider Demographics
NPI:1952761959
Name:PASCUAL, JOHN DAVID (IDC)
Entity Type:Individual
Prefix:
First Name:JOHN DAVID
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 RADFORD BLVD
Mailing Address - Street 2:BLDG 7000
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31704-1130
Mailing Address - Country:US
Mailing Address - Phone:229-639-7886
Mailing Address - Fax:
Practice Address - Street 1:814 RADFORD BLVD
Practice Address - Street 2:BLDG 7000
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31704-1130
Practice Address - Country:US
Practice Address - Phone:229-639-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman