Provider Demographics
NPI:1497914105
Name:KATHY L ANDERSON DO PA
Entity Type:Organization
Organization Name:KATHY L ANDERSON DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-462-5242
Mailing Address - Street 1:510 DRUID RD E
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3950
Mailing Address - Country:US
Mailing Address - Phone:727-462-5242
Mailing Address - Fax:
Practice Address - Street 1:510 DRUID RD E
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3950
Practice Address - Country:US
Practice Address - Phone:727-462-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3200ZMedicare PIN
FLF72094Medicare UPIN