Individual
ROGER D ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 PUTNAM ST, MARIETTA, OH 45750-2924
(740) 374-9990
(740) 374-9993
Mailing address
PO BOX 449, MARIETTA, OH 45750-0449
(740) 374-4500
(740) 374-5887
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35063586
OH
207R00000X
Internal Medicine Physician
35.063586
OH
207RI0200X
Infectious Disease Physician
Primary
35.063586
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000391651
ANTHEM
OH
05
—
0077532001
—
WV
05
—
2276880
—
OH
01
—
P00338056
RRMCR
OH
Enumeration date
08/12/2005
Last updated
09/05/2012
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