Provider Demographics
NPI:1508866336
Name:ANDERSON, DAVID CONRAD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CONRAD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2401 BRANDERMILL BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1690
Mailing Address - Country:US
Mailing Address - Phone:410-721-9862
Mailing Address - Fax:410-721-9865
Practice Address - Street 1:2401 BRANDERMILL BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1690
Practice Address - Country:US
Practice Address - Phone:410-721-9862
Practice Address - Fax:410-721-9865
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2008-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0043236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD80151940OtherRAILROAD MEDICARE
MDP13160OtherCAREFIRST MPOS
MD192191600Medicaid
MD7605-0002OtherCAREFIRST BLUECHOICE
MD525954-02OtherCAREFIRST MD RENDERING
MD0521276OtherAETNA CAPITATED
MD0826714OtherCIGNA PIN
MD242087OtherMAMSI SPECIALIST
MD037532OtherJHHC PROVIDER NUMBER
MD4334366OtherAETNA FEE FOR SERVICE
MH842087OtherMAMSI PRIMARY CARE
MD226L399TMedicare PIN
MD80151940OtherRAILROAD MEDICARE