Provider Demographics
NPI:1932139532
Name:ANDERSON, CHARLES EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWIN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:65 CREEK FARM RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-1190
Mailing Address - Country:US
Mailing Address - Phone:802-879-6544
Mailing Address - Fax:802-879-0022
Practice Address - Street 1:65 CREEK FARM RD
Practice Address - Street 2:SUITE 7
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-1190
Practice Address - Country:US
Practice Address - Phone:802-879-6544
Practice Address - Fax:802-879-0022
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207KA0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT4632Medicare ID - Type Unspecified
VTD78569Medicare UPIN