Individual
LONNIE JAY REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUBMARINE IDC
Contact information
Practice address
55 SOUTH RD APT 12C, GROTON, CT 06340-4660
(224) 436-0181
Mailing address
55 SOUTH RD APT 12C, GROTON, CT 06340-4660
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/09/2020
Last updated
01/09/2020
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