Provider Demographics
NPI:1588009138
Name:ANDERSON, DUSTIN W (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
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 980401
Mailing Address - Street 2:EM: EMERGENCY MEDICINE
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0401
Mailing Address - Country:US
Mailing Address - Phone:804-828-4860
Mailing Address - Fax:804-828-4603
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:EM: EMERGENCY MEDICINE CLINIC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-4860
Practice Address - Fax:804-828-4603
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257467207P00000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program