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NPI Code Detail

MEDICARE: DR. JONATHAN DAVID ANDERSON MD

MEDICARE: DR. JONATHAN DAVID 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
1390200000XStudent in an Organized Health Care Education/Training ProgramNY
2208600000XSurgery Physician57.258551OH

General Provider Information

NPI Number : 1669275889
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN DAVID ANDERSON MD
Provider Business Mailing Address
First Line : 1020 GRAND CONCOURSE APT 19B
Second Line :
City : BRONX
State : NY
Zip : 10451-2638
Country : US
Telephone Number : 917-250-2191
Fax Number :
Provider Business Practice Location Address
First Line : 2500 METROHEALTH DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1900
Country : US
Telephone Number : 216-778-3468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2025
Last Update Date : 04/13/2026

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