Provider Demographics
NPI:1265837090
Name:ANDERSON, MEGAN B (IDC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 CUSHING RD BLDG 624
Mailing Address - Street 2:NBHC NTC,
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2051 CUSHING RD BLDG 624
Practice Address - Street 2:NBHC NTC,
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6173
Practice Address - Country:US
Practice Address - Phone:619-524-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman