Individual
MR. MARIO DELANO PHILLIPS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
745 EDEN WAY NORTH, CHESAPEAKE, VA 23320
(757) 560-2457
Mailing address
MARINE CORPS SECURITY FORCES, MCA 614 PORT AU PRINCE, NORFOLK, VA 23551-0001
(757) 444-6492
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/16/2013
Last updated
04/16/2013
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