Provider Demographics
NPI:1740255140
Name:ANDERSON, CAROL J (NP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5700
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:413-256-4421
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA150448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA123465OtherFALLON
MANP1534OtherBLUE CROSS BLUE SHIELD
MA0351181Medicaid
MA150488OtherCONNECTICARE
MANP1534OtherBLUE CROSS BLUE SHIELD
MA0351181Medicaid