Provider Demographics
NPI:1811067564
Name:ANDERSON, STUART D (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
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 1:90 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1648
Mailing Address - Country:US
Mailing Address - Phone:740-633-4480
Mailing Address - Fax:740-633-4485
Practice Address - Street 1:90 N 4TH ST FL 1
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1648
Practice Address - Country:US
Practice Address - Phone:740-633-4480
Practice Address - Fax:740-633-4485
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066542L207X00000X
OH35081721207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091683Medicaid
PAH56097Medicare UPIN