Healthcare Provider Details

I. General information

NPI: 1760640809
Provider Name (Legal Business Name): PIERRE-LUC PAULTRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FOREST GLEN RD FL 5
SILVER SPRING MD
20910-1460
US

IV. Provider business mailing address

2101 E JEFFERSON ST STE 6W
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-7126
  • Fax: 301-754-7127
Mailing address:
  • Phone: 301-816-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD037383
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0069997
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: