Individual
DR. J. MICHAEL ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 W BELVEDERE AVE, DEPT OF REHAB MEDICINE, BALTIMORE, MD 21215-5216
(410) 601-5850
(410) 601-6124
Mailing address
2401 W BELVEDERE AVE, DEPT OF CREDENTIALING, BALTIMORE, MD 21215-5216
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
D0028126
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250006186
R/R MEDICARE PROVIDER #
MD
05
—
332161400
—
MD
01
—
CA8374
R/R MEDICARE GROUP #
MD
Enumeration date
04/10/2006
Last updated
05/08/2008
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