Individual
GEORGIY O BONDARCHUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DIVE IDC
Contact information
Practice address
1465 HEWITT DR, VIRGINIA BEACH, VA 23459-8523
(757) 462-3991
Mailing address
1465 HEWITT DR, VIRGINIA BEACH, VA 23459-8523
(757) 462-3991
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801350442
NPPES
—
Enumeration date
02/17/2020
Last updated
02/17/2020
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