Provider Demographics
NPI:1588879779
Name:ROWE, RALPH ALLEN JR (IDC)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:ALLEN
Last Name:ROWE
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:209 ROBINHOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7164
Mailing Address - Country:US
Mailing Address - Phone:757-967-4195
Mailing Address - Fax:757-967-4152
Practice Address - Street 1:MOBILE SECURITY SQUADRON SIX
Practice Address - Street 2:NNSY BLD 15
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23709-5000
Practice Address - Country:US
Practice Address - Phone:757-967-4195
Practice Address - Fax:757-967-4152
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman