1982702486 NPI number — MS. DANITA ANDERSON MD

Table of content: MS. DANITA ANDERSON MD (NPI 1982702486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982702486 NPI number — MS. DANITA ANDERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
DANITA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982702486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70178-4148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-212-9518
Provider Business Mailing Address Fax Number:
504-212-9534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4710 S CARROLLTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70119-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-454-9020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  00027672 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD.204101 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-37495 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 631400188 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 631402188 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: I61597 . This is a "HEALTHSPRING OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51537501 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 631403188 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 631404188 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-37494 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-37496 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-37499 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 631407188 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51537500 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-37498 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 631410188 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 631411188 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2133756 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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