Provider Demographics
NPI:1235699810
Name:ANDERSON, THOMAS GORMAN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GORMAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4605
Mailing Address - Country:US
Mailing Address - Phone:646-518-0163
Mailing Address - Fax:
Practice Address - Street 1:100 S RIDING BLVD FL 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3692
Practice Address - Country:US
Practice Address - Phone:302-623-2850
Practice Address - Fax:302-623-2855
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315431207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine