Healthcare Provider Details

I. General information

NPI: 1417949819
Provider Name (Legal Business Name): GUNNAR H ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

IV. Provider business mailing address

1729 BURRSTONE RD
NEW HARTFORD NY
13413-1001
US

V. Phone/Fax

Practice location:
  • Phone: 315-798-1668
  • Fax: 315-798-1536
Mailing address:
  • Phone: 315-798-1668
  • Fax: 315-798-1536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number118177
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: