Healthcare Provider Details

I. General information

NPI: 1093246290
Provider Name (Legal Business Name): FORREST LOYD ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CORNELIA ST
PLATTSBURGH NY
12901-2878
US

IV. Provider business mailing address

622 W 168TH ST PH 11
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 518-314-3560
  • Fax:
Mailing address:
  • Phone: 122-305-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA174992
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number321571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: