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NPI Code Detail

MEDICARE: BONNIE LOUISE ANDERSON MD

MEDICARE: BONNIE LOUISE ANDERSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician22760SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013916022
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE LOUISE ANDERSON MD
Provider Business Mailing Address
First Line : 1 INDEPENDENCE PT STE 212
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-4536
Country : US
Telephone Number : 864-797-6015
Fax Number :
Provider Business Practice Location Address
First Line : 1210 W FARIS RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29605-4444
Country : US
Telephone Number : 864-295-4410
Fax Number : 864-295-5694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 07/22/2015

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Directions to “ BONNIE LOUISE ANDERSON MD” Practice Location

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