1336486224 NPI number — JOHN ALLAN CONNORS IDC

Table of content: JOHN ALLAN CONNORS IDC (NPI 1336486224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336486224 NPI number — JOHN ALLAN CONNORS IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNORS
Provider First Name:
JOHN
Provider Middle Name:
ALLAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336486224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NAVAL SUBMARINE BASE NEW LONDON, BOX 900
Provider Second Line Business Mailing Address:
NAVAL SUBMARINE MEDICAL RESEARCH LABORATORY
Provider Business Mailing Address City Name:
GROTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06349-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-694-2558
Provider Business Mailing Address Fax Number:
860-694-4809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WAHOO DRIVE
Provider Second Line Business Practice Location Address:
NAVAL BRANCH HEALTH CLINIC
Provider Business Practice Location Address City Name:
GROTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-694-4123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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