Provider Demographics
NPI:1538497094
Name:ANDRES C OLACIREGUI, MD.,PC
Entity Type:Organization
Organization Name:ANDRES C OLACIREGUI, MD.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLACIREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-518-1104
Mailing Address - Street 1:1017 HEARTFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2115
Mailing Address - Country:US
Mailing Address - Phone:301-518-1104
Mailing Address - Fax:
Practice Address - Street 1:1017 HEARTFIELDS DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2115
Practice Address - Country:US
Practice Address - Phone:301-518-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
MDMD D0009180261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251S00000XAgenciesCommunity/Behavioral Health