Healthcare Provider Details

I. General information

NPI: 1457298812
Provider Name (Legal Business Name): MARK ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 S MCDOWELL ST
RALEIGH NC
27601-1724
US

IV. Provider business mailing address

53 ALL ABOARD CIR
WILLOW SPRING NC
27592-8256
US

V. Phone/Fax

Practice location:
  • Phone: 919-856-6020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberP113253
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: