MEDICARE: DR. IRVIN BURTON 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
1	208600000X	Surgery Physician	137897	NY

General Provider Information

NPI Number	:	1245203926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRVIN BURTON ANDERSON MD

Provider Business Mailing Address
First Line	:	1847 BEDFORD AVE
Second Line	:	MAPLE MEDICAL OFFICE
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5005
Country	:	US
Telephone Number	:	718-693-6100
Fax Number	:	718-940-4698

Provider Business Practice Location Address
First Line	:	1847 BEDFORD AVE
Second Line	:	MAPLE MEDICAL OFFICE
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5005
Country	:	US
Telephone Number	:	718-693-6100
Fax Number	:	718-940-4698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2006
Last Update Date	:	12/05/2013

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