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Individual provider Active NPI Independent Duty Corpsman · Groton, CT
NPI 1336933902 · NPPES record last updated Apr 8, 2025
Key facts
- NPI
- 1336933902
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Corpsman 1710I1002X
- Practice address
- 390 Burningtree Dr
Groton, CT 06340-3106 - Phone
- (310) 863-1104
- NPI assigned
- Apr 8, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Yes |
Addresses
Primary practice location
390 Burningtree Dr
Groton, CT 06340-3106
Mailing address
390 Burningtree Dr
Groton, CT 06340-3106
Phone (310) 863-1104
Other providers in Groton, CT
- Maria Eulalia Molina Arcilla
- Hamilton Arenas
- Jennifer Mullane Armstrong
- Margot Armstrong
- Dalton John Aron
- Peter T Auerbach
- Kyrah Augmon-Bossa
- Corydon Ali Awwa
- Brianna Ba
- Jennifer N Back
All providers in Groton, CT · Independent Duty Corpsman in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.