Provider Demographics
NPI:1477655090
Name:ANDERSON, CHARLES CRAGIN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CRAGIN
Last Name:ANDERSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 GRAND CENTRAL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 SUPERIOR DR STE 350
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8722
Practice Address - Country:US
Practice Address - Phone:303-666-4343
Practice Address - Fax:303-666-6741
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40017174400000X
CODR.0040017208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG54430Medicare UPIN
CO452858Medicare ID - Type Unspecified