MEDICARE: ANDREW J ANDERSON DO, PC

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1043082423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW J ANDERSON DO, PC

Provider Business Mailing Address
First Line	:	18024 FOREST RD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-4853
Country	:	US
Telephone Number	:	434-214-0722
Fax Number	:

Provider Business Practice Location Address
First Line	:	18024 FOREST RD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-4853
Country	:	US
Telephone Number	:	434-214-0722
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW ANDERSON
Credential	:	DO
Telephone Number	:	434-214-0722

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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