Provider Demographics
NPI:1710144308
Name:ANDRE, LAURENT OLIVIER SR
Entity Type:Individual
Prefix:MR
First Name:LAURENT
Middle Name:OLIVIER
Last Name:ANDRE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-0654
Mailing Address - Country:US
Mailing Address - Phone:301-452-6889
Mailing Address - Fax:
Practice Address - Street 1:4000 VIRGINIA PL
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2632
Practice Address - Country:US
Practice Address - Phone:301-542-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist