Healthcare Provider Details

I. General information

NPI: 1346668399
Provider Name (Legal Business Name): KATHERINE J. ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE J FERRISS

II. Dates (important events)

Enumeration Date: 04/06/2014
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAIL STOP 265SM5
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

81 N MARIO CAPECCHI DR STE 1A.011
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2700
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number10308185-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number290272
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number042.0013826
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042.0013826
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number042.0013826
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: