MEDICARE: TRICIA ANDERSON

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	174V00000X	Clinical Ethicist	897779	NY
2	174400000X	Specialist	897779	NY

General Provider Information

NPI Number	:	1720431190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA ANDERSON

Provider Business Mailing Address
First Line	:	754 CRESCENT STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208
Country	:	US
Telephone Number	:	917-574-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	754 CRESCENT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-4546
Country	:	US
Telephone Number	:	917-574-1314
Fax Number	:

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	02/19/2019

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