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General NPI Number Information
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NPI Number | 1609876606
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Entity Type | Individual
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Provider Name | DERRICK ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2005
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1831 N FAYETTEVILLE ST
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City | ASHEBORO
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State | NC
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Zip | 27203-3273
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Country | US
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Telephone | 336-672-1300
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Fax | 336-672-3044
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Provider Business Mailing Address
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Address Line | 200 E 2ND AVE
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City | GASTONIA
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State | NC
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Zip | 28052-4358
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Country | US
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Telephone | 704-703-7003
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Fax | 704-865-4614
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2021-02612
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License Number State | NC
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