Provider Demographics
NPI:1114546918
Name:ANDERSON, KRISTOPHE MIKHAIL, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHE
Middle Name:MIKHAIL, ANTHONY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:115 HOPE RD, KINGSTON 6
Mailing Address - Street 2:UNIT 6, LIGUANEA POST MALL
Mailing Address - City:KINGSTON 6
Mailing Address - State:OUTSIDE U.S./CANADA
Mailing Address - Zip Code:JMAAW12
Mailing Address - Country:JM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1140 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2412
Practice Address - Country:US
Practice Address - Phone:609-597-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11940000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine