TAREK ANDERSON (NPI# 1841365640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841365640 |
| Entity Type | Individual |
| Full Name | TAREK ANDERSON |
| Credential | M.D. |
| Practice Address |
4605 Maccorkle Ave Sw South Charleston WV 25309-1311 |
| Mailing Address |
Po Box L2560 Columbus OH 43260-0001 |
| Practice Telephone | 3043469400 |
| Practice Fax Number | 3043457320 |
| Mailing Telephone | 3043469400 |
| Mailing Fax Number | 3043457320 |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2008-05-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 35065363 | OH | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 18922 | WV | Allopathic & Osteopathic Physicians |
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
35065363 | OH | Allopathic & Osteopathic Physicians |
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
18922 | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | MOUNTAIN STATE BLUECROSS | W45031 | 01 |
| OH | 0933682 | 05 | |
| CIGNA HEALTHCARE | 3607462003 | 01 | |
| WV | MTN ST BCBS | 001723812 | 01 |
| WV | 0110693000 | 05 | |
| KY | 64103021 | 05 | |
| WV | AETNA | 4505652 | 01 |
| Street Address |
4605 MACCORKLE AVE SW |
| City | SOUTH CHARLESTON |
| State | WV |
| Zip Code | 25309-1311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164425542 | David Abramowitz | Radiology | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2005-05-31 |
| 1609494269 | Tabitha Michelle Spence | Nurse Practitioner | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2020-07-10 |
| 1538781703 | Premier Surgical Assist, Inc. | Surgery | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2020-05-11 |
| 1629690037 | Stephanie Shamma | Nurse Practitioner | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1398 | 2020-05-08 |
| 1174187603 | Herbert J Thomas Memorial Hospital Association | Substance Abuse Rehabilitation Facility | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2019-04-30 |
| 1659856383 | Maccorkle Emergency Physicians Pllc | Physician Assistant | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-09-28 |
| 1386122844 | Hospitalist Medicine Physicians of West Virginia- Tcg, Pllc | Internal Medicine | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-08-06 |
| 1245717222 | Kelsey Leigh Higgins | Speech-Language Pathologist | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-07-23 |
| 1982180709 | Samantha Craigo | Speech-Language Pathologist | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-07-15 |
| 1316430564 | Nicholas E. Clark | Nurse Anesthetist, Certified Registered | 4605 Maccorkle Ave Sw, South Charleston, WV 25309-1311 | 2018-06-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407126717 | David Zell Myerberg | Pediatrics | 237 Lebanon St, Morgantown, WV 26501-6535 | 2012-01-03 |
| 1427315324 | Rebecca Jane Burke | Pediatrics | 1 Medical Center Dr, Morgantown, WV 26506-1200 | 2012-04-16 |
| 1558627356 | Stephen Matthew Akers | Pediatrics | 1 Medical Center Dr, Morgantown, WV 26506 | 2012-04-05 |
| 1992911374 | Greg Barretto | Pediatrics | 1 Medical Center Drive, Morgantown, WV 26506 | 2007-05-15 |
| 1265646319 | Karin Johnson | Pediatrics | 1600 Medical Center Dr, Huntington, WV 25701-3656 | 2007-05-09 |
| 1861535445 | Martha D Mullett | Pediatrics | 1 Stadium Drive, Morgantown, WV 26506 | 2007-02-14 |
| 1033295324 | Petaiah Mohan | Pediatrics | 194 Carriage Dr, Beckley, WV 25801-2804 | 2006-10-28 |
| 1972683076 | Janet E Graeber | Pediatrics | 1 Stadium Drive, Morgantown, WV 26506 | 2006-10-16 |
| 1053491902 | Panitan Yossuck | Pediatrics | 1 Stadium Drive, Morgantown, WV 26506 | 2006-10-16 |
| 1164473534 | Stefan Randolph Maxwell | Pediatrics | 830 Pennsylvania Ave, Suite 406, Charleston, WV 25302-3302 | 2006-05-12 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH CHARLESTON |
| Zip Code | 25309 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.