Provider Demographics
NPI:1750465472
Name:ANDERSEN, BETH A (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2219 BROADWAY E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4135
Mailing Address - Country:US
Mailing Address - Phone:206-499-9585
Mailing Address - Fax:
Practice Address - Street 1:2100 CLINCH AVE STE 120
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2288
Practice Address - Country:US
Practice Address - Phone:865-637-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA000345502088P0231X
ID59615652088P0231X
ORMD2233012088P0231X
CAG186314208800000X
WAMD00034550208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology