Provider Demographics
NPI:1386825685
Name:TONDA M. ANDERSON M.D. PLLC
Entity Type:Organization
Organization Name:TONDA M. ANDERSON M.D. PLLC
Other - Org Name:MOUNT WASHINGTON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TONDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-538-2554
Mailing Address - Street 1:10536 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7338
Mailing Address - Country:US
Mailing Address - Phone:502-538-2554
Mailing Address - Fax:502-538-2426
Practice Address - Street 1:10536 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7338
Practice Address - Country:US
Practice Address - Phone:502-538-2554
Practice Address - Fax:502-538-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9315Medicare PIN