Healthcare Provider Details

I. General information

NPI: 1780847574
Provider Name (Legal Business Name): KATHLEEN G ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW PHC 6 - DEPT OF INTERNAL MEDICINE
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

655 WATKINS MILL RD
GAITHERSBURG MD
20879-3301
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0101248526
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD039005
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberD84734
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: