Provider Demographics
NPI:1821433988
Name:ANDERSON, AMBER HAYDEN (DO)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:HAYDEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4315 PHYSICIANS BLVD
Practice Address - Street 2:STE 101
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7430
Practice Address - Country:US
Practice Address - Phone:704-455-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-02273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine