MEDICARE: DR. MATTHEW TODD 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	208600000X	Surgery Physician	217507	NY

General Provider Information

NPI Number	:	1528155199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW TODD ANDERSON M.D.

Provider Business Mailing Address
First Line	:	100 PARK STREET
Second Line	:	GLENS FALLS HOSPITAL - CREDENTIALING
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-4413
Country	:	US
Telephone Number	:	518-926-5925
Fax Number	:	518-926-6983

Provider Business Practice Location Address
First Line	:	14 HUDSON AVE
Second Line	:	SURGICAL SPECIALISTS OF GLENS FALLS HOSPITAL
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-4448
Country	:	US
Telephone Number	:	518-926-5600
Fax Number	:	518-926-5605

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/14/2022

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