Provider Demographics
NPI:1669790267
Name:ANDERSON, JUDITH CAROLYN (M D)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:CAROLYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 OYSTER ROW
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-2714
Mailing Address - Country:US
Mailing Address - Phone:843-886-9022
Mailing Address - Fax:843-886-9022
Practice Address - Street 1:3 OYSTER ROW
Practice Address - Street 2:
Practice Address - City:ISLE OF PALMS
Practice Address - State:SC
Practice Address - Zip Code:29451-2714
Practice Address - Country:US
Practice Address - Phone:843-886-9022
Practice Address - Fax:843-886-9022
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011544E2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology