Provider Demographics
NPI:1962474619
Name:FANSELAU, ANNEMARIE E (MD)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:E
Last Name:FANSELAU
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:133 N ALTADENA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7325
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8350
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-447-3516
Practice Address - Fax:626-447-8546
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-01-21
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Provider Licenses
StateLicense IDTaxonomies
CAA064663208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics