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General NPI Number Information
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NPI Number | 1922156181
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Entity Type | Individual
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Provider Name | MARK ROBERT ANDERSON M.D., M.SC.
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Gender | Male
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Dates
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Enumeration Date | 01/06/2007
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 500 MARTHA JEFFERSON DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-4668
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Country | US
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Telephone | 434-654-5260
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Fax | 844-340-9731
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Provider Business Mailing Address
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Address Line | PO BOX 9007
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22906-9007
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Country | US
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Telephone |
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Fax |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2011-00424
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101267017
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License Number State | VA
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