436 MEDICAL GRP (NPI# 1740692433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740692433 |
| Entity Type | Organization |
| Organization Name | 436 MEDICAL GRP |
| Other Organization Name | DOD DOVER EPHCY |
| Practice Address |
300 Tuskegee Blvd Dover Afb DE 19902-5003 |
| Mailing Address |
436 Medical Grp Health Care C/o Donald Cole 300 Tuskegee Blvd Dover DE 19901 |
| Practice Telephone | 3026772019 |
| Practice Fax Number | 3026773083 |
| Mailing Telephone | 3026772019 |
| Mailing Fax Number | 3026773083 |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2016-02-15 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2145986 | 01 |
| Other Name | Type Code |
|---|---|
| DoD DOVER ePhcy | Doing Business As Name - Organization |
| Street Address |
300 TUSKEGEE BLVD |
| City | DOVER AFB |
| State | DE |
| Zip Code | 19902-5003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376536813 | Phillip Warren Petterborg | Optometrist | 300 Tuskegee Blvd, Dover Afb, DE 19902-5300 | 2005-08-30 |
| 1578181442 | Jessica Rumsley | Military Health Care Provider | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2020-07-08 |
| 1386125052 | Thomas Brown | Physician Assistant | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2018-08-22 |
| 1871084772 | Catoya Hale | Nurse Practitioner | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2018-05-25 |
| 1104350024 | Bichle Thi Nguyen | Preventive Medicine | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2017-04-18 |
| 1427582659 | Adnan Mehboob | Family Medicine | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2017-04-14 |
| 1003350109 | Stephen Scott Grabner II | Student in an Organized Health Care Education/Training Program | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2016-12-07 |
| 1134588973 | Andrew Kung | Pediatrics | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2016-02-22 |
| 1619357753 | Marisa Romeo | Dentist | 300 Tuskegee Blvd, Bldg 304, Dover Afb, DE 19902-5300 | 2015-06-03 |
| 1811301112 | Lynne Werth | Family Medicine | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2014-06-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316434632 | Leanne Mccarron | Dentist | Dover Afb, 436 Omrs/sgpd, Apo, AA 19902 | 2018-04-23 |
| 1568892446 | Ami Campbell | Veterinarian | 643 Atlantic Ave, Dover, DE 19902 | 2013-11-14 |
| 1609135045 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | Bldg. 266, Arnold Drive, Dover Afb, DE 19902 | 2012-05-04 |
| 1700080363 | Dori Mitchell Franco | Pathology | 115 Purple Heart Ave, Dover Afb, DE 19902 | 2007-06-14 |
| 1235384926 | Terri Lynn Turchan | Social Worker | 300 Tuskegee, Dover Airforce Base, Dover, DE 19902-2849 | 2008-11-21 |
| 1982129300 | Catherine Tien | Dentist | 300 Tuskegee Blvd Bldg 304, Dover Afb, DE 19902-5003 | 2017-08-07 |
| 1679905889 | Jeremiah Goldberg | Social Worker | 300 Tuskegee Blvd Bldg 300, Dover Afb, DE 19902-5003 | 2013-07-30 |
| 1467852871 | Geoffrey Borro | Dietitian, Registered | 300 Tuskegee Blvd Bldg 300, Dover Air Force Base, DE 19902-5003 | 2014-09-04 |
| 1144635350 | Fahad Pervez | Family Medicine | 300 Tuskegee Blvd Bldg 300, Dover Afb, DE 19902-5003 | 2014-06-25 |
| 1215039086 | Alice Jean Briones | Pathology | 115 Purple Heart Ave, Dover Afb, DE 19902-5051 | 2006-09-02 |
| Find all providers in zip 19902 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336248095 | 436 Medical Group | Military/U.S. Coast Guard Pharmacy | 300 Tuskegee Blvd, Dover Afb, DE 19902-5003 | 2006-09-21 |
Please comment or provide details below to improve the information on 436 MEDICAL GRP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.