Provider Demographics
NPI:1629173653
Name:ANDERSEN, ROMNEY CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROMNEY
Middle Name:CHRISTIAN
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12200 WARWICK BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-9988
Practice Address - Fax:757-534-5688
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101056717207X00000X
MDD0062117207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD304033000Medicaid
MD541MR949Medicare PIN
MD1629173653OtherNPI
VA010296391Medicaid