Healthcare Provider Details

I. General information

NPI: 1588642599
Provider Name (Legal Business Name): ERIC LEE ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BYRN ST
CAMBRIDGE MD
21613-1908
US

IV. Provider business mailing address

298 ASTON FOREST LN
CROWNSVILLE MD
21032-1606
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-1000
  • Fax:
Mailing address:
  • Phone: 410-923-0843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0065309
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: