Healthcare Provider Details

I. General information

NPI: 1659332989
Provider Name (Legal Business Name): ROBERT JOSEPH ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE SUITE 240
HAMDEN CT
06518-3691
US

IV. Provider business mailing address

2200 WHITNEY AVE SUITE 240
HAMDEN CT
06518-3691
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-5400
  • Fax: 203-281-3001
Mailing address:
  • Phone: 203-287-5400
  • Fax: 203-281-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21494
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: