Provider Demographics
NPI:1265450415
Name:ANDERSON, ELIZABETH JOAN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1807
Mailing Address - Country:US
Mailing Address - Phone:717-763-7685
Mailing Address - Fax:717-975-2950
Practice Address - Street 1:104 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1807
Practice Address - Country:US
Practice Address - Phone:717-763-7685
Practice Address - Fax:717-975-2950
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049977L207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA742106OtherBLUE SHIELD
PA02087801OtherCAPITAL BLUE CROSS
PA02087801OtherCAPITAL BLUE CROSS
PA742106EMYMedicare ID - Type UnspecifiedMEDICARE