MEDICARE: LEONARD 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	2086S0129X	Vascular Surgery Physician	192394	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1760482863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD ANDERSON MD

Provider Business Mailing Address
First Line	:	346 GRAND AVE
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2580
Country	:	US
Telephone Number	:	607-729-8156
Fax Number	:	607-729-2209

Provider Business Practice Location Address
First Line	:	30 HARRISON ST
Second Line	:	SUITE 455
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2161
Country	:	US
Telephone Number	:	607-763-8100
Fax Number	:	607-763-8048

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/18/2011

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Directions to “ LEONARD ANDERSON MD” Practice Location

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