1700145679 NPI number — DR. ALYSSA KATE ANDERSON M.D.

Table of content: DR. ALYSSA KATE ANDERSON M.D. (NPI 1700145679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700145679 NPI number — DR. ALYSSA KATE ANDERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
ALYSSA
Provider Middle Name:
KATE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
KATE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700145679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 858
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-0858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-243-1455
Provider Business Mailing Address Fax Number:
717-531-7269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CONTINENTAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17022-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-361-0666
Provider Business Practice Location Address Fax Number:
717-361-0202
Provider Enumeration Date:
05/11/2012

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: 207Q00000X , with the licence number:  MD453639 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103044610 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".