Provider Demographics
NPI:1851355143
Name:ANDERSON, ANTHONY K (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:K
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 1:435 ARDEN AVE
Mailing Address - Street 2:# 410
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4020
Mailing Address - Country:US
Mailing Address - Phone:818-242-4191
Mailing Address - Fax:818-242-4811
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:# 410
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4020
Practice Address - Country:US
Practice Address - Phone:818-242-4191
Practice Address - Fax:818-242-4811
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39027207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C390270Medicaid
CA00C390270Medicaid
CAWC39027BMedicare ID - Type Unspecified