Individual
ROGER FABIAN ANDERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11200 GOVERNOR MANLY WAY, SUITE 102, RALEIGH, NC 27614-8595
(919) 570-7550
(919) 570-7551
Mailing address
11200 GOVERNOR MANLY WAY, SUITE 102, RALEIGH, NC 27614-8595
(919) 570-7550
(919) 570-7551
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
30738
SC
2085R0001X
Radiation Oncology Physician
Primary
39233
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11256
BLUE CROSS/BLUE SHIELD
NC
01
—
1528096591
PARTNERS MEDICARE
NC
05
—
8911256
—
NC
05
—
N39233
—
SC
01
—
P00472369
RAILROAD MEDICARE
NC
Enumeration date
06/29/2006
Last updated
03/30/2021
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