Provider Demographics
NPI:1437152378
Name:ANDERSON, JAMES M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3695 GREEN RD UNIT 22778
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7939
Mailing Address - Country:US
Mailing Address - Phone:216-255-5728
Mailing Address - Fax:727-767-3593
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:216-255-5728
Practice Address - Fax:727-767-3593
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME945592085P0229X
CAC1751972085P0229X
KY560152085P0229X
CODR.00670492085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200490900Medicaid
IN200490900Medicaid