Individual
ANATOLIY OLEXANDROVYCH GRYSHCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDHS
Contact information
Practice address
4000 COAST GUARD BLVD, PORTSMOUTH, VA 23703-2135
(757) 483-8710
Mailing address
USCGC TAMPA, 4000 COAST GUARD BLVD, APO, AA 23703
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369535915
DODID
DC
Enumeration date
10/26/2021
Last updated
10/26/2021
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