Basic Information
| Provider Information | |||||||||
| NPI: | 1417374026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERON | ||||||||
| FirstName: | PRESTON | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MS, LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 THOMAS JOHNSON DR | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016207478 | ||||||||
| FaxNumber: | 3016207479 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 THOMAS JOHNSON DR | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217024502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016207478 | ||||||||
| FaxNumber: | 3016207479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2014 | ||||||||
| LastUpdateDate: | 03/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | A0000519 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 2255A2300X | RT005168 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.