# MR. JOHN MARTIN ANDERSEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1891801981
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD 039149E | PA | Yes |

## Other

- **Enumeration date:** 08/22/2006
- **Last updated:** 10/17/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000506727 | INDEPENDENCE BLUE CROSS | — |
| 05 | — | 0011067390001 | — | PA |
| 01 | — | 0109636001 | KHPE/IBC | PA |
| 01 | — | 018149 | AETNA HMO | PA |
| 01 | — | 1025953 | KEYSTONEMERCY HEALTH PLAN | — |
| 01 | — | 232925465 | BLUE CROSS OF DE | — |