Healthcare Provider Details

I. General information

NPI: 1457320699
Provider Name (Legal Business Name): CAROL ELIZABETH ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 A ST CLINICAL GENETICS/SCHC
PHILADELPHIA PA
19134-1043
US

IV. Provider business mailing address

9 HATHAWAY CIR
WYNNEWOOD PA
19096-1901
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-8337
  • Fax: 215-427-8904
Mailing address:
  • Phone: 610-642-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD030421E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: