Healthcare Provider Details

I. General information

NPI: 1356839278
Provider Name (Legal Business Name): LAURENT VICTOR OFFICER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD
LEBANON NH
03766-1970
US

IV. Provider business mailing address

PO BOX 810
HANOVER NH
03755-0810
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5000
  • Fax: 603-640-1228
Mailing address:
  • Phone: 33-081-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24558
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: