MEDICARE: D. ANDA NORBERGS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0056118	FL
2	207RH0003X	Hematology & Oncology Physician	ME0056118	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA6603	OTHER	FL	RRW MEDICARE GROUP
2	K5098	OTHER	FL	MEDICARE ID
4	AE374	OTHER	FL	MEDICARE ID
5	DG4665	OTHER	FL	RRW MEDICARE GROUP
7	P00066801	OTHER	FL	RRW MEDICARE INDIVIDUAL
8	P00437070	OTHER	FL	RRW MEDICARE INDIVIDUAL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	09165	OTHER	FL	BCBS
6	4643415	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1164636932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D. ANDA NORBERGS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 919210
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-9210
Country	:	US
Telephone Number	:	727-789-2595
Fax Number	:	727-789-8891

Provider Business Practice Location Address
First Line	:	4114 WOODLANDS PKWY
Second Line	:	SUITE 301
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3498
Country	:	US
Telephone Number	:	727-789-2595
Fax Number	:	727-789-8891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	04/25/2008

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Directions to “ D. ANDA NORBERGS M.D.” Practice Location

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