Provider Demographics
NPI:1194327213
Name:SUMMERS, JOSEPH (SOIDC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 FIELDSTONE GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5143
Mailing Address - Country:US
Mailing Address - Phone:231-620-2831
Mailing Address - Fax:
Practice Address - Street 1:310 REGULUS AVE
Practice Address - Street 2:
Practice Address - City:DAM NECK ANNEX
Practice Address - State:VA
Practice Address - Zip Code:23451-5584
Practice Address - Country:US
Practice Address - Phone:231-620-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman