Healthcare Provider Details

I. General information

NPI: 1235181892
Provider Name (Legal Business Name): LAURENCE J ANDERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST SUITE 239
PHILADELPHIA PA
19107-5002
US

IV. Provider business mailing address

1020 SANSOM ST SUITE 239
PHILADELPHIA PA
19107-5002
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax: 215-955-2526
Mailing address:
  • Phone: 215-955-6844
  • Fax: 215-955-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52173-21
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101017118
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS0006812L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: