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General NPI Number Information
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NPI Number | 1841365640
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Entity Type | Individual
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Provider Name | TAREK ANDERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 4605 MACCORKLE AVE SW
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1311
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Country | US
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Telephone | 304-346-9400
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Fax | 304-345-7320
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Provider Business Mailing Address
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Address Line | PO BOX L2560
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City | COLUMBUS
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State | OH
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Zip | 43260-0001
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Country | US
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Telephone | 304-346-9400
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Fax | 304-345-7320
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 18922
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35065363
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 18922
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 35065363
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License Number State | OH
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