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NPI Code Detail

MEDICARE: LORI L ANDERSON MD

MEDICARE: LORI L 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
1207Q00000XFamily Medicine Physician204107NY

General Provider Information

NPI Number : 1134104979
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI L ANDERSON MD
Provider Business Mailing Address
First Line : 1001 W FAYETTE ST
Second Line : STE 400
City : SYRACUSE
State : NY
Zip : 13204-2859
Country : US
Telephone Number : 315-472-1488
Fax Number : 315-472-8060
Provider Business Practice Location Address
First Line : 308 W SENECA ST
Second Line :
City : MANLIUS
State : NY
Zip : 13104-2318
Country : US
Telephone Number : 315-682-5080
Fax Number : 315-682-8847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 06/08/2009

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Directions to “ LORI L ANDERSON MD” Practice Location

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