# UNITED STATES NAVY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962959478
- **Authorized official:** DR. JAMES J MUCCIARONE M.D. (COMMANDER / OIC NAVAL UNDERSEA MED)
- **Authorized official phone:** (860) 694-6483

## Contact information

- **Practice address:** 1 CRYSTAL LAKE RD, BLDG 159 NAVAL UNDERSEA MEDICAL INST. NAVSUBASE NLON, GROTON, CT 06349-2300
- **Practice address phone:** (860) 694-6483
- **Mailing address:** 1 CRYSTAL LAKE ROAD, BLDG 159 NAVAL UNDERSEA MEDICAL INST. NAVSUBASE NLON, GROTON, CT 06340

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1710I1002X | Independent Duty Corpsman | — | NULL | Yes |
| 1710I1002X | Independent Duty Corpsman | — | — | Yes |

## Other

- **Enumeration date:** 09/01/2016
- **Last updated:** 09/01/2016