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General NPI Number Information
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NPI Number | 1245309103
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Entity Type | Individual
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Provider Name | MARK B ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD 3RD FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-8270
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Fax | 215-456-3533
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Provider Business Mailing Address
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Address Line | 30 PROSPECT AVE
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City | HACKENSACK
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State | NJ
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Zip | 07601-1915
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Country | US
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Telephone | 551-996-2880
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Fax | 551-996-3984
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD445899
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License Number State | PA
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