Basic Information
Provider Information | |||||||||
NPI: | 1780974121 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANDERSON | ||||||||
FirstName: | LAURA | ||||||||
MiddleName: | SPECTOR | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SPECTOR | ||||||||
OtherFirstName: | LAURA | ||||||||
OtherMiddleName: | ALISON | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1 MEDICAL CENTER BLVD | ||||||||
Address2: |   | ||||||||
City: | CHESTER | ||||||||
State: | PA | ||||||||
PostalCode: | 190133902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6104476643 | ||||||||
FaxNumber: | 8089475805 | ||||||||
Practice Location | |||||||||
Address1: | 1 MEDICAL CENTER BLVD STE ACP 333 | ||||||||
Address2: |   | ||||||||
City: | CHESTER | ||||||||
State: | PA | ||||||||
PostalCode: | 190133902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6108724900 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2011 | ||||||||
LastUpdateDate: | 08/19/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VC0200X | DOS 1668 | HI | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Critical Care Medicine | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207V00000X | DOS1668 | HI | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.