Provider Demographics
NPI:1023571122
Name:ANDERSON, COLIN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:ROBERT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 RUTLEDGE AVE RUTLEDGE TOWER. MSC CODE: 591
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-792-2900
Mailing Address - Fax:
Practice Address - Street 1:135 RUTLEDGE TOWER RUTLEDGE TOWER. M
Practice Address - Street 2:
Practice Address - City:CH
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66092207R00000X
SC89576207R00000X
AZR77234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine