Healthcare Provider Details

I. General information

NPI: 1811804396
Provider Name (Legal Business Name): MR. BRET DAVID ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

604 UPPER FIELD CIR
WESTMINSTER MD
21158-4441
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2775
  • Fax:
Mailing address:
  • Phone: 410-554-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License NumberR146175
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: