Provider Demographics
NPI:1760521017
Name:ANDERSON, ANDREA ANTOINETTE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANTOINETTE
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 1:1101 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-5002
Mailing Address - Country:US
Mailing Address - Phone:202-798-0100
Mailing Address - Fax:202-379-3570
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW STE 450
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2261
Practice Address - Fax:202-741-2921
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024905300Medicaid