Healthcare Provider Details

I. General information

NPI: 1962604728
Provider Name (Legal Business Name): TROY G ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 01/25/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N BROAD STREET EXT
GROVE CITY PA
16127-4603
US

IV. Provider business mailing address

403 DEER PATH LN
NEW WILMINGTON PA
16142-3505
US

V. Phone/Fax

Practice location:
  • Phone: 724-450-7000
  • Fax:
Mailing address:
  • Phone: 724-944-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number34.009137CTR
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34.009137CTR
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberOS015644
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS015644
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: