MEDICARE: ARNE JOHN 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
1	2080P0006X	Developmental - Behavioral Pediatrics Physician	D0041412	MD
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	2019-02862	NC

General Provider Information

NPI Number	:	1528060209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARNE JOHN ANDERSON MD

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-716-0238
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 SILAS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3013
Country	:	US
Telephone Number	:	336-713-7429
Fax Number	:	336-713-7842

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	04/05/2022

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Directions to “ ARNE JOHN ANDERSON MD” Practice Location

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