Provider Demographics
NPI:1982268645
Name:ANDRE, MINERVA (DO)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GALEN ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4913
Mailing Address - Country:US
Mailing Address - Phone:202-279-1817
Mailing Address - Fax:202-617-2985
Practice Address - Street 1:1500 GALEN ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4913
Practice Address - Country:US
Practice Address - Phone:202-279-1817
Practice Address - Fax:202-617-2985
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO210001355207Q00000X
SCLL82126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine