Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD030421E | PA |
NPI | 1457320699 |
---|---|
Provider Name | Dr. Carol Elizabeth Anderson |
First Address | Wynnewood, PA 19096-1901 |
Second Address | Philadelphia, PA 19134-1043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01164300504 | (05) | PA |
A43800 | (02) |