Provider Demographics
NPI:1346334489
Name:ANDERSEN, HAROLD FRANK (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:FRANK
Last Name:ANDERSEN
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 1:1321 COLBY AVE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1665
Mailing Address - Country:US
Mailing Address - Phone:425-525-3316
Mailing Address - Fax:
Practice Address - Street 1:900 PACIFIC AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4168
Practice Address - Country:US
Practice Address - Phone:425-304-6165
Practice Address - Fax:425-304-6162
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046175207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8450371Medicaid
WA8450371Medicaid
WAA79672Medicare UPIN
WAG8878185Medicare PIN