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NPI Code Detail

MEDICARE: MARK WENDELL ANDERSON MD

MEDICARE: MARK WENDELL ANDERSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician200400098NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184628844
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK WENDELL ANDERSON MD
Provider Business Mailing Address
First Line : PO BOX 7200
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-0200
Country : US
Telephone Number : 252-937-0200
Fax Number : 252-451-0056
Provider Business Practice Location Address
First Line : 901 N WINSTEAD AVE
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-8467
Country : US
Telephone Number : 252-937-0231
Fax Number : 252-937-3113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 11/07/2023

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