Organization
U.S. COAST GUARD
Active
Other names
u.s. coast guard academy clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCHON RUSSELL (CHIEF)
(860) 701-6736
Entity
Organization
Contact information
Practice address
15 MOHEGAN AVE, NEW LONDON, CT 06320-8100
(860) 444-8402
Mailing address
15 MOHEGAN AVE, NEW LONDON, CT 06320-8100
(860) 444-8402
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Enumeration date
08/05/2007
Last updated
08/05/2007
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