Provider Demographics
NPI:1861490278
Name:ANDEN, COREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:D
Last Name:ANDEN
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:PO BOX 27688
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0688
Mailing Address - Country:US
Mailing Address - Phone:801-534-1360
Mailing Address - Fax:801-366-9883
Practice Address - Street 1:4403 HARRISON BLVD STE 1875
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3325
Practice Address - Country:US
Practice Address - Phone:801-387-2090
Practice Address - Fax:801-387-6606
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17802912052081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB41744Medicare UPIN
UT005759601Medicare PIN