Provider Demographics
NPI:1659332989
Name:ANDERSON, ROBERT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
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 1:2200 WHITNEY AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3691
Mailing Address - Country:US
Mailing Address - Phone:203-287-5400
Mailing Address - Fax:203-281-3001
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-287-5400
Practice Address - Fax:203-281-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT21494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT713024OtherCONNECTICARE
CT001214949Medicaid
CT010021494CT02OtherANTHEM BLUE CROSS
CT0Q1368OtherHEALTHNET
CT1240955OtherUNITED HEALTHCARE
CTP490157OtherOXFORD
CTP490157OtherOXFORD
CT001214949Medicaid