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General NPI Number Information
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NPI Number | 1063611267
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Entity Type | Organization
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Legal Business Name | PETER ANDERSON
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 1 OLD PARK LN SUITE 2
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City | NEW MILFORD
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State | CT
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Zip | 06776-2562
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Country | US
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Telephone | 860-355-3728
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Fax | 860-355-4253
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Provider Business Mailing Address
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Address Line | 1 OLD PARK LN SUITE 2
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City | NEW MILFORD
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State | CT
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Zip | 06776-2562
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Country | US
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Telephone | 860-355-3728
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Fax | 860-355-4253
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Authorized Official
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Title or Position | PCP
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Name | DR. PETER LLOYD ANDERSON
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Credential | M.D.
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Telephone | 860-355-3728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 000613
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 025352
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License Number State | CT
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