Healthcare Provider Details

I. General information

NPI: 1760496855
Provider Name (Legal Business Name): ELDRIDGE T ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRENTWOOD DR SUITE B
ITHACA NY
14850-1865
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 607-266-0073
  • Fax: 607-266-9310
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number173533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: