Provider Demographics
NPI:1477581643
Name:ANDERSON, CHARLES COLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:COLLINS
Last Name:ANDERSON
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 1:106 ANDERSON TRL
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-4142
Mailing Address - Country:US
Mailing Address - Phone:434-392-5846
Mailing Address - Fax:434-315-0229
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4308
Practice Address - Country:US
Practice Address - Phone:804-254-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026246207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005868874Medicaid
VA005868866Medicaid
VA005869943Medicaid
VA005868882Medicaid
VA1477581643Medicaid
VA005868858Medicaid
VA930002249Medicare PIN
VA930002251Medicare PIN
VA110008345Medicare PIN
VA005869943Medicaid
VA005868858Medicaid
VA1477581643Medicaid
VAVAA104343Medicare PIN