MEDICARE: DR. TONDA M. ANDERSON M.D.

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	38446	KY

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	:	1649278359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONDA M. ANDERSON M.D.

Provider Business Mailing Address
First Line	:	10536 HIGHWAY 44 E
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-7338
Country	:	US
Telephone Number	:	502-538-2554
Fax Number	:	502-538-2426

Provider Business Practice Location Address
First Line	:	10536 HIGHWAY 44 E
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-7338
Country	:	US
Telephone Number	:	502-538-2554
Fax Number	:	502-538-2426

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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