MEDICARE: DR. KENT THOMAS ANDERSON M.D.

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	207R00000X	Internal Medicine Physician	27354	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11516	OTHER	NC	BC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P00165585	OTHER		RRMC

General Provider Information

NPI Number	:	1487650669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT THOMAS ANDERSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3775
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27895-3775
Country	:	US
Telephone Number	:	252-291-1928
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 FOREST HILLS RD W STE B
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3392
Country	:	US
Telephone Number	:	252-991-0555
Fax Number	:	252-991-0596

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/26/2015

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