Provider Demographics
NPI:1487650669
Name:ANDERSON, KENT THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:THOMAS
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:PO BOX 3775
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-3775
Mailing Address - Country:US
Mailing Address - Phone:252-291-1928
Mailing Address - Fax:
Practice Address - Street 1:2503 FOREST HILLS RD W STE B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3392
Practice Address - Country:US
Practice Address - Phone:252-991-0555
Practice Address - Fax:252-991-0596
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11516OtherBC
NC8911516Medicaid
NC891154RMedicaid
P00165585OtherRRMC
NC2330011Medicare PIN
NC891154RMedicaid
NC11516OtherBC