Provider Demographics
NPI:1891005484
Name:ANDERSON, JOSHUA ALAN (MS, PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ALAN
Last Name:ANDERSON
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Gender:M
Credentials:MS, PA-C
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Mailing Address - Street 1:4801 DORSEY HALL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7766
Mailing Address - Country:US
Mailing Address - Phone:410-997-5191
Mailing Address - Fax:410-997-7957
Practice Address - Street 1:4801 DORSEY HALL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7766
Practice Address - Country:US
Practice Address - Phone:410-997-5191
Practice Address - Fax:410-997-7957
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2015-06-25
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Provider Licenses
StateLicense IDTaxonomies
MDC0004351363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD392387ZJKVMedicare PIN