Andrew Dean Anderson, MD
Individual provider Active NPI General Practice Physician · Camp Pendleton, CA
NPI 1992384804 · NPPES record last updated Aug 29, 2022
Key facts
- NPI
- 1992384804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 0101275806 (VA)
- Practice address
- 200 Mercy Circle Drive
Camp Pendleton, CA 92055 - Phone
- (909) 855-0012
- NPI assigned
- Apr 7, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220909001169 | VA | Order and Referring Only - General Practice |
2769867860 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| General Practice Physician | 208D00000X | 0101275806 | VA | Yes |
Addresses
Primary practice location
200 Mercy Circle Drive
Camp Pendleton, CA 92055
Mailing address
PO Box 555191
Camp Pendleton, CA 92055-5191
Phone (909) 855-0012
Other providers in Camp Pendleton, CA
- Leticia Isabel Alcantar
- Alice-Anne Thompson Alcorn
- David M Allen
- Ethan Caleb Amdahl
- Paimon Ameli
- Natalie June Anderson
- Heather Annis
- Eric Appelsies
- Manolito Arciaga
- Chales Anthony Arena
All providers in Camp Pendleton, CA · General Practice Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.