Provider Demographics
NPI:1033211792
Name:ANDERSON, PHILIP R (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 LANDMARK HILL RTE 1
Mailing Address - Street 2:A7
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-2500
Mailing Address - Country:US
Mailing Address - Phone:207-439-0019
Mailing Address - Fax:207-439-0015
Practice Address - Street 1:518 LANDMARK HILL RTE 1
Practice Address - Street 2:A7
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-2500
Practice Address - Country:US
Practice Address - Phone:207-439-0019
Practice Address - Fax:207-439-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6018208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81026883Medicaid
NH0106883Y0NH01OtherANTHEM BC/BS
MEME2289Medicare PIN
NHNH6883Medicare ID - Type Unspecified
NH81026883Medicaid