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1760119887
DEREK CALLOWAY
GROTON, CT
NPI
1760119887
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2022-08-08
Last Update Date
2022-08-08
Business Address
DEREK CALLOWAY IDC
159 TROUT AVE
GROTON, CT 06349-5159
Phone number: 860-694-2876
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Mailing Address
DEREK CALLOWAY IDC
87 MICHAEL RD APT E
NEW LONDON, CT 06320-2432
Phone number:
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