Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 6018 | NH |
Y | 208600000X | Surgeon | 6018 | NH |
N | 2086S0129X | Vascular Surgeon | 6018 | NH |
NPI | 1033211792 |
---|---|
Provider Name | Dr. Philip R. Anderson |
First Address | Kittery, ME 03904-2500 |
Second Address | Kittery, ME 03904-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 18/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0106883Y0NH01 | ANTHEM BC/BS (01) | NH |
81026883 | (05) | NH |
D03483 | (02) | NH |