Provider Demographics
NPI:1790776516
Name:ANDERSON, RICHARD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
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 1:299 CAREW ST STE 323
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2431
Mailing Address - Country:US
Mailing Address - Phone:413-732-9600
Mailing Address - Fax:413-732-9621
Practice Address - Street 1:299 CAREW ST STE 323
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-732-9600
Practice Address - Fax:413-732-9621
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79633174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9787461Medicaid
MA9787461Medicaid
MAJ14720Medicare PIN