Healthcare Provider Details

I. General information

NPI: 1144884222
Provider Name (Legal Business Name): BRITT ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT. OF PSYCHOLOGY, UNIVERSITY OF WATERLOO 200 UNIVERSITY AVENUE WEST
WATERLOO ONTARIO
N2L3G1
CA

IV. Provider business mailing address

DEPT. OF PSYCHOLOGY, UNIVERSITY OF WATERLOO 200 UNIVERSITY AVENUE WEST
WATERLOO ONTARIO
N2L3G1
CA

V. Phone/Fax

Practice location:
  • Phone: 519-888-4567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10451
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: