Provider Demographics
NPI:1023111606
Name:ANDERSEN, CHARLOTTE MARIE (MD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:MARIE
Other - Last Name:BALCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:BADGER
Mailing Address - State:SD
Mailing Address - Zip Code:57214
Mailing Address - Country:US
Mailing Address - Phone:605-983-5087
Mailing Address - Fax:605-983-4796
Practice Address - Street 1:510 4TH STREET S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58107
Practice Address - Country:US
Practice Address - Phone:701-476-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND101562084P0800X
MOMDR36572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13798OtherMEDICAID
ND26728OtherBCBS
A25298Medicare UPIN