Healthcare Provider Details

I. General information

NPI: 1902243231
Provider Name (Legal Business Name): ANDREW LUHRS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 COLLYER ST STE 302
PROVIDENCE RI
02904-1869
US

IV. Provider business mailing address

PO BOX 16149
RUMFORD RI
02916-0697
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-5701
  • Fax: 401-793-5171
Mailing address:
  • Phone: 401-453-9625
  • Fax: 401-435-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLP02765
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD16693
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: