Provider Demographics
NPI:1710560636
Name:RICE, ANSON THOMAS (SOIDC, ATP, FPC)
Entity type:Individual
Prefix:MR
First Name:ANSON
Middle Name:THOMAS
Last Name:RICE
Suffix:
Gender:M
Credentials:SOIDC, ATP, FPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NSWDG 402 POLARIS STREET
Mailing Address - Street 2:BLD 586
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23461
Mailing Address - Country:US
Mailing Address - Phone:757-862-2725
Mailing Address - Fax:
Practice Address - Street 1:NSWDG 402 POLARIS STREET
Practice Address - Street 2:BLDG 586
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461
Practice Address - Country:US
Practice Address - Phone:757-862-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman