Provider Demographics
NPI:1922139195
Name:ANDERSON, DEBRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:S
Last Name:ANDERSON
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 1:4460 RED BANK RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2173
Mailing Address - Country:US
Mailing Address - Phone:513-579-9191
Mailing Address - Fax:513-579-0350
Practice Address - Street 1:4460 RED BANK RD STE 130
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2173
Practice Address - Country:US
Practice Address - Phone:513-579-9191
Practice Address - Fax:513-579-0350
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050641207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0710298Medicaid
OHAN 0617691Medicare ID - Type Unspecified
OHA 83067Medicare UPIN