Healthcare Provider Details

I. General information

NPI: 1790776516
Provider Name (Legal Business Name): RICHARD PAUL ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST STE 323
SPRINGFIELD MA
01104
US

IV. Provider business mailing address

299 CAREW ST STE 323
SPRINGFIELD MA
01104-2431
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-9600
  • Fax: 413-732-9621
Mailing address:
  • Phone: 413-732-9600
  • Fax: 413-732-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number79633
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: