Provider Demographics
NPI:1578520359
Name:ANDERSON, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
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:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:417 N 11TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5002
Practice Address - Country:US
Practice Address - Phone:804-828-2775
Practice Address - Fax:804-828-0191
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043142L208G00000X
IN01064289A208G00000X
IA21833208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42128384946Medicaid
IA0414607Medicaid
IN201006530Medicaid
IA38321OtherWELLMARK BCBS IA
PA101854586Medicaid
IA7714360Medicaid
IN000000694554OtherANTHEM PROVIDER NUMBER
INM400035283Medicare PIN
IA7714360Medicaid
IAI15052Medicare ID - Type UnspecifiedPART B IOWA
PA627992Medicare PIN
IA0414607Medicaid
INP00949956Medicare PIN