Healthcare Provider Details

I. General information

NPI: 1508866336
Provider Name (Legal Business Name): DAVID CONRAD ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BRANDERMILL BLVD SUITE 360
GAMBRILLS MD
21054-1690
US

IV. Provider business mailing address

2401 BRANDERMILL BLVD SUITE 360
GAMBRILLS MD
21054-1690
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-9862
  • Fax: 410-721-9865
Mailing address:
  • Phone: 410-721-9862
  • Fax: 410-721-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0043236
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: