Provider Demographics
NPI:1205037959
Name:ANDERSON, CHIQUITIA JENEE (MD)
Entity Type:Individual
Prefix:
First Name:CHIQUITIA
Middle Name:JENEE
Last Name:ANDERSON
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 1:8640 SUDLEY RD STE 306
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-330-3939
Mailing Address - Fax:703-331-0959
Practice Address - Street 1:8640 SUDLEY RD STE 306
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:703-330-3939
Practice Address - Fax:703-331-0959
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086076208000000X
VA0101248451208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics