Provider Demographics
NPI:1033825146
Name:PAGEAU, ANDRE (SOIDC)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:PAGEAU
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MARINE RAIDER BATTALION PSC BOX 20073
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0073
Mailing Address - Country:US
Mailing Address - Phone:702-466-5059
Mailing Address - Fax:
Practice Address - Street 1:3D MARINE RAIDER BATTALION
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-2854
Practice Address - Country:US
Practice Address - Phone:702-466-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman