Healthcare Provider Details

I. General information

NPI: 1780853390
Provider Name (Legal Business Name): RICHARD E. ANDERSON, M.D., RICHARD L. ANDERSON, M.D., A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE SUITE 200
BURBANK CA
91505-4402
US

IV. Provider business mailing address

2701 W ALAMEDA AVE SUITE 200
BURBANK CA
91505-4402
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-4192
  • Fax: 818-955-8598
Mailing address:
  • Phone: 818-843-4192
  • Fax: 818-955-8598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD LANE ANDERSON
Title or Position: VICE PRESIDENT AND SECRETARY
Credential: M.D.
Phone: 818-843-4192