Provider Demographics
NPI:1679589642
Name:ANDERSON, JOHN W (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DO
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 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-689-1110
Mailing Address - Fax:540-689-1119
Practice Address - Street 1:2010 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-1110
Practice Address - Fax:540-689-1119
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201457208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679589642Medicaid
VA1000870001OtherDME PROVIDER
7452945OtherCIGNA
WV1841866000OtherWV MEDICAID
P00055467OtherRAILROAD MEDICARE
VA002410R54Medicare PIN
H91916Medicare UPIN
VA66644OtherOPTIMA
266913OtherANTHEM/BCBS
318984OtherSOUTHERN HEALTH
VA010014026Medicaid