Healthcare Provider Details

I. General information

NPI: 1205812443
Provider Name (Legal Business Name): ERIC M ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HANCOCK ST
QUINCY MA
02169-4339
US

IV. Provider business mailing address

147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
BOSTON MA
02109-4806
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-0600
  • Fax: 617-774-0211
Mailing address:
  • Phone: 617-559-8053
  • Fax: 617-421-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224212
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: