Provider Demographics
NPI:1780622563
Name:ANDERS, JOEL W (DO)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:W
Last Name:ANDERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JOEL
Other - Middle Name:WILLIAM
Other - Last Name:ANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1822
Mailing Address - Country:US
Mailing Address - Phone:220-564-4151
Mailing Address - Fax:220-564-7153
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1822
Practice Address - Country:US
Practice Address - Phone:220-564-4151
Practice Address - Fax:220-564-7153
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008639207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2655318Medicaid
OH2655318Medicaid