Healthcare Provider Details

I. General information

NPI: 1346231537
Provider Name (Legal Business Name): JENNIFER ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4934
US

IV. Provider business mailing address

201 CEDAR ST SE STE 508
ALBUQUERQUE NM
87106-4925
US

V. Phone/Fax

Practice location:
  • Phone: 617-841-1090
  • Fax:
Mailing address:
  • Phone: 505-563-6392
  • Fax: 505-563-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number219842
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number219842
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD2007-0090
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: