1275593576 NPI number — MRS. CYNTHIA W ANDERSON ANP

Table of content: MRS. CYNTHIA W ANDERSON ANP (NPI 1275593576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275593576 NPI number — MRS. CYNTHIA W ANDERSON ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CYNTHIA
Provider Middle Name:
W
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275593576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 SIGMA DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SUMMERVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29486-7715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-569-1856
Provider Business Mailing Address Fax Number:
843-569-1879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9313 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-569-1856
Provider Business Practice Location Address Fax Number:
843-569-1879
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  1064 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01584163 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: NP1324 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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