Provider Demographics
NPI:1205020161
Name:ANDERSON, PAULETTE D (MD)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 MORGNEC RD
Mailing Address - Street 2:APARTMENT 201K
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1030
Mailing Address - Country:US
Mailing Address - Phone:410-810-1562
Mailing Address - Fax:
Practice Address - Street 1:300 SCHEELER RD
Practice Address - Street 2:UPPER SHORE COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1014
Practice Address - Country:US
Practice Address - Phone:410-778-6800
Practice Address - Fax:410-778-1648
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00477562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB00162Medicare UPIN