Provider Demographics
NPI:1528394244
Name:CHARLA L. ANDERSON, M.D.
Entity Type:Organization
Organization Name:CHARLA L. ANDERSON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-234-3400
Mailing Address - Street 1:2115 CHAPLINE ST
Mailing Address - Street 2:VALLEY PROFESSIONAL CENTER, SUITE 101
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3859
Mailing Address - Country:US
Mailing Address - Phone:304-234-3400
Mailing Address - Fax:304-234-3401
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:VALLEY PROFESSIONAL CENTER, SUITE 101
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3859
Practice Address - Country:US
Practice Address - Phone:304-234-3400
Practice Address - Fax:304-234-3401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLA L. ANDERSON, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty