Provider Demographics
NPI:1629042817
Name:ANDERSON, JONATHAN CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHRISTIAN
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 1:78 MEDICAL CENTER DR
Mailing Address - Street 2:CROSSROADS
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2332
Mailing Address - Country:US
Mailing Address - Phone:540-213-2525
Mailing Address - Fax:540-213-2525
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:CROSSROADS
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-213-2525
Practice Address - Fax:540-213-2525
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA851915OtherFIRST HEALTH
VA175282OtherANTHEM
VA085211MOtherOPTIMA HEALTH
VA085211MOtherOPTIMA HEALTH
VAG05429Medicare UPIN
VA851915OtherFIRST HEALTH