MEDICARE: DR. VIRGINIA MARIE 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	207ZP0213X	Pediatric Pathology Physician	108602	NY

General Provider Information

NPI Number	:	1407810229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA MARIE ANDERSON MD

Provider Business Mailing Address
First Line	:	10 WARREN ST
Second Line	:
City	:	RUMSON
State	:	NJ
Zip	:	07760-2012
Country	:	US
Telephone Number	:	732-530-9576
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 CLARKSON AVENUE
Second Line	:	DOWNSTATE MEDICAL CENTER (MSC 25)
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2097
Country	:	US
Telephone Number	:	718-270-1294
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	09/26/2013

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