MEDICARE: JOHN M. ANDERSEN 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	MD039149E	PA

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	:	1932497807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M. ANDERSEN M.D.

Provider Business Mailing Address
First Line	:	933 N CHARLOTTE ST
Second Line	:	SUITE 3-A
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-3974
Country	:	US
Telephone Number	:	610-323-9052
Fax Number	:	610-323-3085

Provider Business Practice Location Address
First Line	:	933 N CHARLOTTE ST
Second Line	:	SUITE 3-A
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-3974
Country	:	US
Telephone Number	:	610-323-9052
Fax Number	:	610-323-3085

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LEANNE ANDERSEN
Credential	:
Telephone Number	:	610-718-0165

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2011

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