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NPI Code Detail

MEDICARE: DR. MARCELLA M ANDERSON M.D.

MEDICARE: DR. MARCELLA 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
1208000000XPediatrics PhysicianMD14903OR

Other Identifiers

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

General Provider Information

NPI Number : 1710982459
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCELLA M ANDERSON M.D.
Provider Business Mailing Address
First Line : 2435 NE CUMULUS AVE STE A
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-8862
Country : US
Telephone Number : 503-472-6161
Fax Number : 503-434-6290
Provider Business Practice Location Address
First Line : 2435 NE CUMULUS AVE STE A
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-8862
Country : US
Telephone Number : 503-472-6161
Fax Number : 503-434-6290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 01/09/2013

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