Provider Demographics
NPI:1346386828
Name:ANDERSON, HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
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 1:116 E CENTER ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5215
Mailing Address - Country:US
Mailing Address - Phone:860-646-2451
Mailing Address - Fax:860-646-6388
Practice Address - Street 1:116 E CENTER ST
Practice Address - Street 2:SUITE 14
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5215
Practice Address - Country:US
Practice Address - Phone:860-646-2451
Practice Address - Fax:860-646-6388
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020769208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC59711Medicare UPIN