Provider Demographics
NPI:1497795686
Name:ANDERSCHAT, JOHN FRED (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRED
Last Name:ANDERSCHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1527
Mailing Address - Country:US
Mailing Address - Phone:301-585-1155
Mailing Address - Fax:301-585-2597
Practice Address - Street 1:1515 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1527
Practice Address - Country:US
Practice Address - Phone:301-585-1155
Practice Address - Fax:301-585-2597
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD18653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD005511500Medicaid
MD005511500Medicaid
MD26921Medicare ID - Type Unspecified