NPI 1336582774

Mario Delano Phillips, IDC

Practitioner Independent Duty Corpsman Chesapeake, VA

Practice location

Address: 745 Eden Way North, Chesapeake, VA 23320
Phone: (757) 560-2457
Mailing address: Marine Corps Security Forces McA 614 Port Au Prince, Norfolk, VA 23551-0001

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1336582774
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Apr 2013
Record last updated: 16 Apr 2013

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.