Provider Demographics
NPI:1437843612
Name:ANDERSON, ELDRIE A
Entity Type:Individual
Prefix:
First Name:ELDRIE
Middle Name:A
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 1:17 HIAWATHA TRL
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2007
Mailing Address - Country:US
Mailing Address - Phone:585-414-8480
Mailing Address - Fax:
Practice Address - Street 1:1200A SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5703
Practice Address - Country:US
Practice Address - Phone:585-713-5974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)