Individual
TAREK ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 346-9400
(304) 345-7320
Mailing address
PO BOX L2560, COLUMBUS, OH 43260-0001
(304) 346-9400
(304) 345-7320
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
18922
WV
208000000X
Pediatrics Physician
35065363
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
18922
WV
2080N0001X
Neonatal-Perinatal Medicine Physician
35065363
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001723812
MTN ST BCBS
WV
05
—
0110693000
—
WV
05
—
0933682
—
OH
01
—
3607462003
CIGNA HEALTHCARE
—
01
—
4505652
AETNA
WV
05
—
64103021
—
KY
01
—
W45031
MOUNTAIN STATE BLUECROSS
WV
Enumeration date
11/21/2006
Last updated
05/27/2008
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