NPI 1013430016

Ivan Leavitt Brown

Practitioner Independent Duty Corpsman Groton, CT

Practice location

Address: 159 Trout Avenue Subase New London, Groton, CT 06340
Phone: (847) 254-3904
Mailing address: 235 Charter Oak Dr, Groton, CT 06340-2934

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1013430016
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 Jul 2017
Record last updated: 21 Jul 2017

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.