Individual
MR. RANDALL FREDERICK DIERKING JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1 WAHOO AVE, UNDERSEA MEDICINE, GROTON, CT 06340-2324
(860) 449-4247
Mailing address
7 HART ST, GROTON, CT 06340-3321
(860) 405-0343
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/03/2006
Last updated
05/03/2010
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