Basic Information
| Provider Information | |||||||||
| NPI: | 1982702486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | DANITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4148 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701784148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042129518 | ||||||||
| FaxNumber: | 5042129534 | ||||||||
| Practice Location | |||||||||
| Address1: | 4710 S CARROLLTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044549020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 00027672 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.204101 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 515-37495 | 01 | AL | BLUECROSS BLUESHIELD | OTHER | 631400188 | 05 | AL | MEDICAID | 631402188 | 05 | AL | MEDICAID | I61597 | 01 | AL | HEALTHSPRING OF ALABAMA | OTHER | 51537501 | 01 | AL | BLUECROSS BLUESHIELD | OTHER | 631403188 | 05 | AL | MEDICAID | 631404188 | 05 | AL | MEDICAID | 515-37494 | 01 | AL | BLUECROSS BLUESHIELD | OTHER | 515-37496 | 01 | AL | BLUECROSS BLUESHIELD | OTHER | 515-37499 | 01 | AL | BLUECROSS BLUESHIELD | OTHER | 631407188 | 05 | AL | MEDICAID | 51537500 | 01 | AL | BLUECROSS BLUESHIELD | OTHER | 515-37498 | 01 | AL | BLUECROSS BLUESHIELD | OTHER | 631410188 | 05 | AL | MEDICAID | 631411188 | 05 | AL | MEDICAID | 2133756 | 05 | LA | MEDICAID |