Provider Demographics
NPI:1427323112
Name:SAWIN, MERCEDES RAE (IDC)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:RAE
Last Name:SAWIN
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 FAYVER AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2408
Mailing Address - Country:US
Mailing Address - Phone:413-441-5197
Mailing Address - Fax:
Practice Address - Street 1:USS ROSS DDG 71
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09586-1288
Practice Address - Country:US
Practice Address - Phone:757-444-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman