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General NPI Number Information
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NPI Number | 1184628844
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Entity Type | Individual
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Provider Name | MARK WENDELL ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 901 N WINSTEAD AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-8467
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Country | US
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Telephone | 252-937-0231
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Fax | 252-937-3113
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Provider Business Mailing Address
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Address Line | PO BOX 7200
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-0200
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Country | US
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Telephone | 252-937-0200
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Fax | 252-451-0056
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 200400098
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License Number State | NC
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