Provider Demographics
NPI:1699942961
Name:ERNEST T. ANDERSON, MD, PC
Entity type:Organization
Organization Name:ERNEST T. ANDERSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-482-1140
Mailing Address - Street 1:780 BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1914
Mailing Address - Country:US
Mailing Address - Phone:585-482-1140
Mailing Address - Fax:585-288-7751
Practice Address - Street 1:780 BLOSSOM RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1914
Practice Address - Country:US
Practice Address - Phone:585-482-1140
Practice Address - Fax:585-288-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47398261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD01720Medicare UPIN