Provider Demographics
NPI:1760417885
Name:CRIDER, ANJA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANJA
Middle Name:
Last Name:CRIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S 336TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6311
Mailing Address - Country:US
Mailing Address - Phone:253-237-0610
Mailing Address - Fax:253-237-0606
Practice Address - Street 1:900 S 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6311
Practice Address - Country:US
Practice Address - Phone:253-237-0610
Practice Address - Fax:253-237-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033511207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0196394OtherL & I
WA0226420OtherL & I
WA8905614OtherCRIME VICTIMS
WA8943711OtherCRIME VICTIMS
WAP00288822OtherRAILROAD
WA0226421OtherL & I
WA8422057Medicaid
WA8945690OtherCRIME VICTIMS
WA0217751OtherL & I
WA8422057Medicaid
WAG8855071Medicare PIN
WA8945690OtherCRIME VICTIMS
WAG8869023Medicare PIN