MEDICARE: DR. JEFFREY WALTER ANDERSON D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	H45955	MD
2	2081P0004X	Spinal Cord Injury Medicine Physician	H45955	MD

Other Identifiers

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

General Provider Information

NPI Number	:	1255334454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY WALTER ANDERSON D.O.

Provider Business Mailing Address
First Line	:	614 EASTERN SHORE DR STE C
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-5940
Country	:	US
Telephone Number	:	443-260-2660
Fax Number	:	443-260-2754

Provider Business Practice Location Address
First Line	:	100 E CARROLL ST
Second Line	:	#400
City	:	SALISBURY
State	:	MD
Zip	:	21801-5422
Country	:	US
Telephone Number	:	410-543-7530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/07/2023

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