Provider Demographics
NPI:1477819118
Name:ANDERSON, CORRIE (DO)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WHITE SPRUCE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1607
Mailing Address - Country:US
Mailing Address - Phone:585-461-5940
Mailing Address - Fax:
Practice Address - Street 1:125 WHITE SPRUCE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1607
Practice Address - Country:US
Practice Address - Phone:585-461-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283591207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology