Provider Demographics
NPI:1033284757
Name:ANDERSON, ROSA M (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-355-2184
Mailing Address - Fax:317-355-7329
Practice Address - Street 1:10122 E 10TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2887
Practice Address - Country:US
Practice Address - Phone:317-355-7337
Practice Address - Fax:317-355-7329
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
IN01062155A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000525317OtherANTHEM
IN200870150Medicaid
IN214400BMedicare PIN
INM400043072Medicare PIN