Provider Demographics
NPI:1609849173
Name:ANDERSON, GALVIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:GALVIN
Middle Name:D
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 1:116 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2102
Mailing Address - Country:US
Mailing Address - Phone:716-701-6881
Mailing Address - Fax:716-701-6854
Practice Address - Street 1:2956 AIRWAY RD
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9329
Practice Address - Country:US
Practice Address - Phone:585-593-6738
Practice Address - Fax:585-593-6768
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00961326Medicaid
NYRA2328Medicare PIN
NYB71090Medicare UPIN