Individual provider · NPI-1

Caleb Jeffrey Anderson, PA-C

Physician Assistant · Glen Burnie, MD

NPI number1477312429
StatusActive
Last updated in NPPESMar 13, 2024

Details

NPI
1477312429
Entity type
Individual (NPI-1)
Name
Caleb Jeffrey Anderson
Credential
PA-C
Sex
Male
Sole proprietor
No
Enumeration date
Mar 13, 2024
Certification date
Mar 13, 2024
Last updated
Mar 13, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantC0009311MDYes

Practice location

301 Hospital Dr
Glen Burnie, MD 21061-5803

Phone 410-787-4000

Mailing address

5671 Kingsmill Dr
Salisbury, MD 21801-7472

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