Provider Demographics
NPI:1588655914
Name:ANDERSON, FELTON (MD)
Entity Type:Individual
Prefix:
First Name:FELTON
Middle Name:
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 1:106 IRVING ST NW
Mailing Address - Street 2:SUITE 314 SOUTH
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-877-5290
Mailing Address - Fax:202-877-5292
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 314 SOUTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-5290
Practice Address - Fax:202-877-5292
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041182207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCH914OtherBLUE SHIELD DC
MD760451301Medicaid
DC026587800Medicaid
DCDB5199OtherRR MEDICARE
DCH914OtherBLUE SHIELD DC
F35267Medicare UPIN