Healthcare Provider Details

I. General information

NPI: 1932267085
Provider Name (Legal Business Name): RONALD LEE ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE SUITE 102
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

106 IRVING ST NW POB SUITE 214 SOUTH TOWER
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-5700
  • Fax: 202-610-1861
Mailing address:
  • Phone: 202-877-6944
  • Fax: 202-877-6955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD25663
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD25663
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: