Provider Demographics
NPI:1598781015
Name:ANDERSON, RICHARD HAROLD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HAROLD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:185 CENTER ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4100
Mailing Address - Country:US
Mailing Address - Phone:203-269-6512
Mailing Address - Fax:203-284-3447
Practice Address - Street 1:185 CENTER ST
Practice Address - Street 2:SUITE F
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4100
Practice Address - Country:US
Practice Address - Phone:203-269-6512
Practice Address - Fax:203-284-3447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0222852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1222850Medicaid
CT1222850Medicaid