Provider Demographics
NPI:1750565081
Name:DUDLEY B. ANDERSON, M.D., P.A.
Entity type:Organization
Organization Name:DUDLEY B. ANDERSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:BUIST
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-291-3100
Mailing Address - Street 1:PO BOX 3146
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27895-3146
Mailing Address - Country:US
Mailing Address - Phone:252-291-3100
Mailing Address - Fax:252-243-0599
Practice Address - Street 1:1812 GLENDALE DR. SUITE B SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-291-3100
Practice Address - Fax:252-243-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17235207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911120Medicaid
NC11120OtherBCBS
NCC82599Medicare UPIN
NC8911120Medicaid