Healthcare Provider Details

I. General information

NPI: 1679532220
Provider Name (Legal Business Name): ANDREA D HULSE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MUSGROVE RD #105
SILVER SPRING MD
20904-5202
US

IV. Provider business mailing address

2415 MUSGROVE RD #105
SILVER SPRING MD
20904-5202
US

V. Phone/Fax

Practice location:
  • Phone: 301-989-0193
  • Fax: 301-879-2325
Mailing address:
  • Phone: 301-989-0193
  • Fax: 301-879-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0073074
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: