Healthcare Provider Details

I. General information

NPI: 1497795686
Provider Name (Legal Business Name): JOHN FRED ANDERSCHAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HIGHLAND DR
SILVER SPRING MD
20910-1527
US

IV. Provider business mailing address

1515 HIGHLAND DR
SILVER SPRING MD
20910-1527
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-1155
  • Fax: 301-585-2597
Mailing address:
  • Phone: 301-585-1155
  • Fax: 301-585-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD18653
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier005511500
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: