Healthcare Provider Details

I. General information

NPI: 1881724649
Provider Name (Legal Business Name): MARIA T ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4743 ARAPAHOE AVE STE 201
BOULDER CO
80303-1128
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-442-2395
  • Fax: 303-442-1073
Mailing address:
  • Phone: 303-442-2395
  • Fax: 303-442-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number43571
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number65383
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number65383
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number43571
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: