Provider Demographics
NPI:1104121888
Name:AMERICAN LASER CENTER
Entity type:Organization
Organization Name:AMERICAN LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBGYN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERRIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-225-0005
Mailing Address - Street 1:11921 ROCKVILLE PIKE STE 409
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11921 ROCKVILLE PIKE STE 409
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2757
Practice Address - Country:US
Practice Address - Phone:301-225-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty