NPI 1750631685

US Navy

Organisation Exclusive Provider Organization Groton, CT

Practice location

Address: 207 Hickory Dr, Groton, CT 06340-2946
Phone: (361) 522-5925

Authorised official

Name: Ismael Arturo Lopez
Title: Sub Idc
Phone: (361) 522-5925

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Connecticut →

Registry record

NPI: 1750631685
Entity type: Organization
NPI issued: 18 Sep 2012
Record last updated: 18 Sep 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.