Provider Demographics
NPI:1164636932
Name:NORBERGS, D. ANDA (MD)
Entity Type:Individual
Prefix:
First Name:D. ANDA
Middle Name:
Last Name:NORBERGS
Suffix:
Gender:F
Credentials:MD
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 919210
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9210
Mailing Address - Country:US
Mailing Address - Phone:727-789-2595
Mailing Address - Fax:727-789-8891
Practice Address - Street 1:4114 WOODLANDS PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3498
Practice Address - Country:US
Practice Address - Phone:727-789-2595
Practice Address - Fax:727-789-8891
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056118174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA6603OtherRRW MEDICARE GROUP
FLK5098OtherMEDICARE ID
FL09165OtherBCBS
FLAE374OtherMEDICARE ID
FLDG4665OtherRRW MEDICARE GROUP
FL4643415OtherAETNA
FLP00066801OtherRRW MEDICARE INDIVIDUAL
FLP00437070OtherRRW MEDICARE INDIVIDUAL
FLD91721Medicare UPIN
FLK5098OtherMEDICARE ID