Provider Demographics
NPI:1649278359
Name:ANDERSON, TONDA M (MD)
Entity type:Individual
Prefix:DR
First Name:TONDA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10536 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7338
Mailing Address - Country:US
Mailing Address - Phone:502-538-2554
Mailing Address - Fax:502-538-2426
Practice Address - Street 1:10536 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7338
Practice Address - Country:US
Practice Address - Phone:502-538-2554
Practice Address - Fax:502-538-2426
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64081284Medicaid
KY64081284Medicaid
KY0931501Medicare ID - Type Unspecified