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General NPI Number Information
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NPI Number | 1710144308
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Entity Type | Individual
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Provider Name | MR. LAURENT OLIVIER ANDRE SR.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 4000 VIRGINIA PL
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City | BETHESDA
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State | MD
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Zip | 20816-2632
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Country | US
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Telephone | 301-542-6889
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 654
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City | CABIN JOHN
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State | MD
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Zip | 20818-0654
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Country | US
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Telephone | 301-452-6889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | U01325
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License Number State | MD
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