Healthcare Provider Details

I. General information

NPI: 1033101431
Provider Name (Legal Business Name): CRAIG WARREN ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 E STATE ST SUITE 520
COLUMBUS OH
43215-4354
US

IV. Provider business mailing address

285 E STATE ST SUITE 520
COLUMBUS OH
43215-4354
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9683
  • Fax: 614-566-8046
Mailing address:
  • Phone: 614-566-9683
  • Fax: 614-566-8046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number039701
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: