{
"Npi": {
"NPI": "1588808034",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ANDERSON",
"FirstName": "ERIC",
"MiddleName": "ROBERT",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D., PH.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2411 DULLES CORNER PARK STE 475",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HERNDON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "20171-5605",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-762-9244",
"MailingAddressFaxNumber": "786-672-6006",
"FirstLinePracticeLocationAddress": "2411 DULLES CORNER PARK STE 475",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HERNDON",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "20171-5605",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "800-762-9244",
"PracticeLocationAddressFaxNumber": "786-672-6006",
"EnumerationDate": "04/28/2009",
"LastUpdateDate": "12/23/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084N0400X",
"TaxonomyName": "Neurology Physician",
"LicenseNumber": "0101263537",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0400X",
"TaxonomyName": "Neurology Physician",
"LicenseNumber": "50903",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0400X",
"TaxonomyName": "Neurology Physician",
"LicenseNumber": "MD-42422",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0400X",
"TaxonomyName": "Neurology Physician",
"LicenseNumber": "036-138634",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0600X",
"TaxonomyName": "Clinical Neurophysiology Physician",
"LicenseNumber": "47414",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0600X",
"TaxonomyName": "Clinical Neurophysiology Physician",
"LicenseNumber": "35.124440",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0600X",
"TaxonomyName": "Clinical Neurophysiology Physician",
"LicenseNumber": "69752",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2084N0400X",
"TaxonomyName": "Neurology Physician",
"LicenseNumber": "ME132445",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}