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Organization
SOUTHSIDE INTERNAL MEDICINE-PEDIATRICS LLC
Active
Organization
SOUTHSIDE INTERNAL MEDICINE-PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA M ANDERSON MD (OWNER)
(814) 677-4045
Entity
Organization
Contact information
Practice address
204 CENTRAL AVE, OIL CITY, PA 16301-2738
(814) 677-4045
(814) 676-2364
Mailing address
204 CENTRAL AVE, OIL CITY, PA 16301-2738
(814) 677-4045
(814) 676-2364
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD072420L
PA
208000000X
Pediatrics Physician
MD072420L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018239070003
—
PA
Enumeration date
09/14/2006
Last updated
11/19/2009
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