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General NPI Number Information
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NPI Number | 1043237613
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Entity Type | Individual
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Provider Name | CONSTANCE L. ANDERSON D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1320 MAPLEWOOD AVE STE A
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City | RONCEVERTE
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State | WV
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Zip | 24970-8016
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Country | US
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Telephone | 304-647-5114
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 MAPLEWOOD AVE
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City | RONCEVERTE
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State | WV
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Zip | 24970-8016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1731
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License Number State | WV
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