Provider Demographics
NPI:1669439527
Name:ANDERSON, CHARLES ALBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALBIN
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 1:1225 CAMPBELL WAY, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2623
Mailing Address - Country:US
Mailing Address - Phone:360-377-1355
Mailing Address - Fax:360-377-1558
Practice Address - Street 1:1225 CAMPBELL WAY
Practice Address - Street 2:STE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2623
Practice Address - Country:US
Practice Address - Phone:360-377-1355
Practice Address - Fax:360-377-1558
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200301208G00000X
GA67273208G00000X
WAMD00046401208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1015838Medicaid
GA003121160BMedicaid
GA003121160AMedicaid
WA8861198Medicare UPIN
WA8454530Medicaid
202I782197Medicare PIN