1487638748 NPI number — THOMAS M ANDERSON M.D.

Table of content: THOMAS M ANDERSON M.D. (NPI 1487638748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487638748 NPI number — THOMAS M ANDERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
THOMAS
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487638748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1198
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15501-0336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-444-1918
Provider Business Mailing Address Fax Number:
814-444-9782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10455 LINCOLN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15537-7046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-444-1918
Provider Business Practice Location Address Fax Number:
814-444-9782
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD072398L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0676306000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 332610 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 217176 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 407301100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117880 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01183011505 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1514715 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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