Provider Demographics
NPI:1881865590
Name:ANDERSSON, KRISTINA E (DO)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:E
Last Name:ANDERSSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 BALTIMORE AVE
Mailing Address - Street 2:SUITE T1
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1966
Mailing Address - Country:US
Mailing Address - Phone:301-277-2779
Mailing Address - Fax:301-277-6947
Practice Address - Street 1:6103 BALTIMORE AVE
Practice Address - Street 2:SUITE T1
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1966
Practice Address - Country:US
Practice Address - Phone:301-277-2779
Practice Address - Fax:301-277-6947
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0067114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics