Healthcare Provider Details

I. General information

NPI: 1003858234
Provider Name (Legal Business Name): THOMAS M ANDERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 W BROAD ST
COLUMBUS OH
43228-1609
US

IV. Provider business mailing address

PO BOX 951822
CLEVELAND OH
44193-0020
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-1930
  • Fax: 614-544-1928
Mailing address:
  • Phone: 740-687-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number34003809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: