Provider Demographics
NPI:1932229291
Name:RICHARD J. ANDOLSEN, MD INC.
Entity type:Organization
Organization Name:RICHARD J. ANDOLSEN, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDOLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-433-3369
Mailing Address - Street 1:465 MARCH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3371
Mailing Address - Country:US
Mailing Address - Phone:707-433-3369
Mailing Address - Fax:707-433-7013
Practice Address - Street 1:465 MARCH AVE STE A
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3371
Practice Address - Country:US
Practice Address - Phone:707-433-3369
Practice Address - Fax:707-433-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G319400Medicaid
CA00G319400Medicaid
CAA44919Medicare UPIN