Provider Demographics
NPI:1982702486
Name:ANDERSON, DANITA (MD)
Entity Type:Individual
Prefix:MS
First Name:DANITA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
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:PO BOX 4148
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70178-4148
Mailing Address - Country:US
Mailing Address - Phone:504-212-9518
Mailing Address - Fax:504-212-9534
Practice Address - Street 1:4710 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6027
Practice Address - Country:US
Practice Address - Phone:504-454-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00027672207Q00000X
LAMD.204101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-37495OtherBLUECROSS BLUESHIELD
AL631400188Medicaid
AL631402188Medicaid
ALI61597OtherHEALTHSPRING OF ALABAMA
AL51537501OtherBLUECROSS BLUESHIELD
AL631403188Medicaid
AL631404188Medicaid
AL515-37494OtherBLUECROSS BLUESHIELD
AL515-37496OtherBLUECROSS BLUESHIELD
AL515-37499OtherBLUECROSS BLUESHIELD
AL631407188Medicaid
AL51537500OtherBLUECROSS BLUESHIELD
AL515-37498OtherBLUECROSS BLUESHIELD
AL631410188Medicaid
AL631411188Medicaid
LA2133756Medicaid
AL515-37498OtherBLUECROSS BLUESHIELD
AL631403188Medicaid