Provider Demographics
NPI:1285497685
Name:GLANVILLE, ANDRE RICHARD
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:RICHARD
Last Name:GLANVILLE
Suffix:
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 1:1421 MARYLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5036
Mailing Address - Country:US
Mailing Address - Phone:202-520-9184
Mailing Address - Fax:
Practice Address - Street 1:1421 MARYLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5036
Practice Address - Country:US
Practice Address - Phone:202-520-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant