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NPI Code Detail

MEDICARE: DR. RUDOLPH CLINTON ANDERSON JR. DPM

MEDICARE: DR. RUDOLPH CLINTON ANDERSON JR. DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist0103001041VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275526501
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUDOLPH CLINTON ANDERSON JR. DPM
Provider Business Mailing Address
First Line : 1600 N BEAUREGARD ST STE 300
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22311-1732
Country : US
Telephone Number : 703-940-3810
Fax Number : 703-940-3811
Provider Business Practice Location Address
First Line : 1600 N BEAUREGARD ST STE 300
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22311-1732
Country : US
Telephone Number : 703-940-3810
Fax Number : 703-940-3811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 12/30/2020

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