Organization
NAVAL BRANCH HEALTH CLINIC NEW ENGLAND
Active
Other names
Naval Ambulatory Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK MAMMOTH (MEDICAL STAFF PROFESSIONAL SERVICES)
(860) 694-2377
Entity
Organization
Contact information
Practice address
1 WAHOO AVE, GROTON, CT 06349-2324
(860) 694-4725
Mailing address
PO BOX 600, GROTON, CT 06349-5600
(860) 694-4725
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
R170002
MD
Other
Enumeration date
08/28/2012
Last updated
08/28/2012
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