Provider Demographics
NPI:1093828857
Name:CARPENTIER, ANDRE ROBERT (IDC)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:ROBERT
Last Name:CARPENTIER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-1106
Mailing Address - Country:US
Mailing Address - Phone:401-765-8667
Mailing Address - Fax:860-694-3874
Practice Address - Street 1:USS MIAMI SSN-755
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09578-2411
Practice Address - Country:US
Practice Address - Phone:860-694-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman