Provider Demographics
NPI:1962959478
Name:UNITED STATES NAVY
Entity type:Organization
Organization Name:UNITED STATES NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMANDER / OIC NAVAL UNDERSEA MED
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUCCIARONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-694-6483
Mailing Address - Street 1:1 CRYSTAL LAKE ROAD
Mailing Address - Street 2:BLDG 159 NAVAL UNDERSEA MEDICAL INST. NAVSUBASE NLON
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 CRYSTAL LAKE RD
Practice Address - Street 2:BLDG 159 NAVAL UNDERSEA MEDICAL INST. NAVSUBASE NLON
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-2300
Practice Address - Country:US
Practice Address - Phone:860-694-6483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Multi-Specialty