Basic Information
| Provider Information | |||||||||
| NPI: | 1730325416 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOUYOUDJIAN | ||||||||
| FirstName: | LAURE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12510 PROSPERITY DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209041663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404855200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5550 FRIENDSHIP BLVD | ||||||||
| Address2: | SUITE T-90 | ||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208157256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016542521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2008 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | C0003851 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.