Healthcare Provider Details

I. General information

NPI: 1992707749
Provider Name (Legal Business Name): JOSEPH BENSON ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

9237 UNIVERSITY BLVD
NORTH CHARLESTON SC
29406-9189
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-6400
  • Fax:
Mailing address:
  • Phone: 843-789-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD048161L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberMD048161L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD83226
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: