Healthcare Provider Details

I. General information

NPI: 1891754826
Provider Name (Legal Business Name): JOHN E ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7000
  • Fax:
Mailing address:
  • Phone: 443-777-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0058631
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: