MEDICARE: JAMES ANDERSON

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	363A00000X	Physician Assistant	004931-1	NY

General Provider Information

NPI Number	:	1932314218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ANDERSON

Provider Business Mailing Address
First Line	:	318 RUHLE RD S
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019
Country	:	US
Telephone Number	:	518-899-4133
Fax Number	:	518-899-5764

Provider Business Practice Location Address
First Line	:	318 RUHLE RD S
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1030
Country	:	US
Telephone Number	:	518-899-4133
Fax Number	:	518-899-5764

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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Directions to “ JAMES ANDERSON ” Practice Location

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