Provider Demographics
NPI:1265460067
Name:ANDERSON, DENNIS ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROY
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 1:132 WESTBURY PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8351
Mailing Address - Country:US
Mailing Address - Phone:803-732-2554
Mailing Address - Fax:
Practice Address - Street 1:132 WESTBURY PL
Practice Address - Street 2:SUITE 221
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8351
Practice Address - Country:US
Practice Address - Phone:803-732-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD176077591Medicare UPIN
SC7591Medicare ID - Type Unspecified