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General NPI Number Information
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NPI Number | 1528096591
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Entity Type | Individual
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Provider Name | ROGER FABIAN ANDERSON JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 11200 GOVERNOR MANLY WAY SUITE 102
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City | RALEIGH
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State | NC
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Zip | 27614-8595
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Country | US
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Telephone | 919-570-7550
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Fax | 919-570-7551
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Provider Business Mailing Address
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Address Line | 11200 GOVERNOR MANLY WAY SUITE 102
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City | RALEIGH
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State | NC
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Zip | 27614-8595
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Country | US
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Telephone | 919-570-7550
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Fax | 919-570-7551
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 30738
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 39233
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License Number State | NC
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