Provider Demographics
NPI:1922171099
Name:ANEGAWA, NORIFUSA JOHN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NORIFUSA
Middle Name:JOHN
Last Name:ANEGAWA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2302
Mailing Address - Country:US
Mailing Address - Phone:650-321-4121
Mailing Address - Fax:
Practice Address - Street 1:795 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2302
Practice Address - Country:US
Practice Address - Phone:650-321-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI130152084N0400X
CAG853662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI010825661OtherCHAMP VA PROVIDER ID
HI0000252148OtherHMSA PROVIDER ID
HIP00233290OtherRAILROAD MEDICARE ID
HI010825661OtherTRICARE FOR LIFE ID
HI010825661OtherTRICARE PROVIDER ID
HI100372Medicaid
HI010825661OtherHMAA PROVIDER ID