Provider Demographics
NPI:1902939614
Name:ANDERSON, MICHAEL HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAROLD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 BEVERLY RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3600
Mailing Address - Country:US
Mailing Address - Phone:703-790-3110
Mailing Address - Fax:703-790-3282
Practice Address - Street 1:1364 BEVERLY RD
Practice Address - Street 2:SUITE 303
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3600
Practice Address - Country:US
Practice Address - Phone:703-790-3110
Practice Address - Fax:703-790-3282
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010577392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry