1558507442 NPI number — DONALD CHARLES ORTON IDC

Table of content: DONALD CHARLES ORTON IDC (NPI 1558507442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558507442 NPI number — DONALD CHARLES ORTON IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTON
Provider First Name:
DONALD
Provider Middle Name:
CHARLES
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:
1558507442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NAVAL STATION NORFOLK
Provider Second Line Business Mailing Address:
BLDG CEP 171
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-444-0126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8857 1ST ST BLDG CEP 86 SUITE 400
Provider Second Line Business Practice Location Address:
PCD COMMANDER PRECOMDET NEW YORK (LPD 21) C/O DDG CLASS
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23511-3719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-444-0126
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2008

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)