Healthcare Provider Details

I. General information

NPI: 1033202825
Provider Name (Legal Business Name): PETER M. ANDERSON M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD MEDICAL CENTER PLAZA, SUITE 601
CHARLOTTE NC
28203-5866
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-9900
  • Fax: 704-381-8848
Mailing address:
  • Phone: 704-381-9900
  • Fax: 704-381-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberM4688
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number26793
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: