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General NPI Number Information
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NPI Number | 1689676264
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Entity Type | Individual
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Provider Name | ROGER D ANDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 101 PUTNAM ST
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City | MARIETTA
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State | OH
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Zip | 45750-2924
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Country | US
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Telephone | 740-374-9990
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Fax | 740-374-9993
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Provider Business Mailing Address
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Address Line | PO BOX 449
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City | MARIETTA
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State | OH
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Zip | 45750-0449
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Country | US
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Telephone | 740-374-4500
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Fax | 740-374-5887
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35063586
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 35.063586
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.063586
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License Number State | OH
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