Provider Demographics
NPI:1780853390
Name:RICHARD E. ANDERSON, M.D., RICHARD L. ANDERSON, M.D., A MEDICAL CORP
Entity Type:Organization
Organization Name:RICHARD E. ANDERSON, M.D., RICHARD L. ANDERSON, M.D., A MEDICAL CORP
Other - Org Name:ANDERSON MEDICAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-843-4192
Mailing Address - Street 1:2701 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4402
Mailing Address - Country:US
Mailing Address - Phone:818-843-4192
Mailing Address - Fax:818-955-8598
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4402
Practice Address - Country:US
Practice Address - Phone:818-843-4192
Practice Address - Fax:818-955-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW5853Medicare PIN