Provider Demographics
NPI:1588808034
Name:ANDERSON, ERIC ROBERT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 DULLES CORNER PARK STE 475
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5605
Mailing Address - Country:US
Mailing Address - Phone:800-762-9244
Mailing Address - Fax:786-672-6006
Practice Address - Street 1:2411 DULLES CORNER PARK STE 475
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-5605
Practice Address - Country:US
Practice Address - Phone:800-762-9244
Practice Address - Fax:786-672-6006
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012635372084N0400X
AZ509032084N0400X
IAMD-424222084N0400X
IL036-1386342084N0400X
KY474142084N0600X
OH35.1244402084N0600X
GA697522084N0600X
FLME1324452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2565399Medicaid
IAMISC.Medicaid
AZ999395Medicaid