Provider Demographics
NPI:1538135900
Name:ANDERSEN, WILLIAM KARL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KARL
Last Name:ANDERSEN
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 1:190 N POINTE BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601
Mailing Address - Country:US
Mailing Address - Phone:717-560-6444
Mailing Address - Fax:717-569-1044
Practice Address - Street 1:190 N POINTE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-560-6444
Practice Address - Fax:717-569-1044
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061425L207N00000X, 207ND0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97763Medicare UPIN
PA900246U6PMedicare PIN