Healthcare Provider Details

I. General information

NPI: 1245354752
Provider Name (Legal Business Name): THEODORE STARBUCK ANDERSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N ELM ST SUITE 400
GREENSBORO NC
27401-2878
US

IV. Provider business mailing address

122 N ELM ST SUITE 400
GREENSBORO NC
27401-2878
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-5601
  • Fax: 336-334-5657
Mailing address:
  • Phone: 336-334-5601
  • Fax: 336-334-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20092
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: