MEDICARE: DR. RICHARD D ANDERSEN D.O.

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	207P00000X	Emergency Medicine Physician	34006648	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477531176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD D ANDERSEN D.O.

Provider Business Mailing Address
First Line	:	1900 23RD ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1404
Country	:	US
Telephone Number	:	330-971-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 23RD ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1404
Country	:	US
Telephone Number	:	330-971-7436
Fax Number	:	330-971-7344

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/17/2009

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