Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | OT016341 | PA |
N | 208600000X | Surgeon | OT016341 | PA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 303882 | NY |
NPI | 1124400759 |
---|---|
Provider Name | Dr. Douglas Anderson |
First Address | Brooklyn, NY 11249-3266 |
Second Address | Manhasset, NY 11030-3876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 15/06/2021 |