Provider Demographics
NPI:1457320699
Name:ANDERSON, CAROL ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ELIZABETH
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 1:9 HATHAWAY CIR
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1901
Mailing Address - Country:US
Mailing Address - Phone:610-642-7073
Mailing Address - Fax:
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:CLINICAL GENETICS/SCHC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-8337
Practice Address - Fax:215-427-8904
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030421E207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01164300504Medicaid
PA01164300504Medicaid