Provider Demographics
NPI:1831348838
Name:PEARSON, SEAN GREGORY (IDC)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:GREGORY
Last Name:PEARSON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TARAWA CT STE 260
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-3235
Mailing Address - Country:US
Mailing Address - Phone:757-462-7403
Mailing Address - Fax:757-462-4292
Practice Address - Street 1:2600 TARAWA CT STE 260
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-3235
Practice Address - Country:US
Practice Address - Phone:757-462-7403
Practice Address - Fax:757-462-4292
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman