Individual
JOHN RYAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12101 CAROL LN, FREDERICKSBURG, VA 22407-6101
(540) 786-7810
(540) 786-3099
Mailing address
PO BOX 1460, FREDERICKSBURG, VA 22402-1460
(540) 786-2100
(540) 786-0677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101040122
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000090765
AETNA CAP
VA
05
—
005654432
—
VA
01
—
0101040122
LICENSE
VA
01
—
0897726
AETNA HMO
VA
01
—
175034
ANTHEM
VA
01
—
4091285
AETNA NON HMO
VA
01
—
82934
MAMSI
VA
01
—
C02375
MEDICARE GROUP
VA
01
—
CA9037
MCR RAILROAD GROUP
VA
Enumeration date
01/17/2006
Last updated
03/21/2012
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