Healthcare Provider Details

I. General information

NPI: 1760445514
Provider Name (Legal Business Name): ANTHONY SHANE ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GREEN VALLEY RD STE 308
GREENSBORO NC
27408-7731
US

IV. Provider business mailing address

PO BOX 10176
GREENSBORO NC
27404-0176
US

V. Phone/Fax

Practice location:
  • Phone: 336-580-8499
  • Fax:
Mailing address:
  • Phone: 336-580-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2005-01558
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number2005-01558
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: