Provider Demographics
NPI:1376292599
Name:ANDERSON, MATTHEW TERRELL (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TERRELL
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 1:816 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5283
Mailing Address - Country:US
Mailing Address - Phone:317-681-4207
Mailing Address - Fax:
Practice Address - Street 1:8414 NAAB RD STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1972
Practice Address - Country:US
Practice Address - Phone:317-338-7510
Practice Address - Fax:317-338-7540
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program