Individual provider Active NPI

Carol F Anderson, DDS

  • Dentist
  • Baltimore, MD
National Provider Identifier
1104116565
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10042 Issued in MD
Practice address
650 W Baltimore St
Baltimore, MD 21201-1510
Phone
(301) 928-3771
NPI assigned
Apr 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10042 MD Primary
Dentist 122300000X 0126 NC

Addresses

Primary practice location

650 W Baltimore St
Baltimore, MD 21201-1510

Mailing address

11102 Glenn Brook CT
Glenn Dale, MD 20769-9200
Phone (301) 928-3771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160802000010 NC Practitioner - Dentist 9133412919 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10042MDMDDentist
0126NCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina University Current Accepting new patients
East Carolina University Dentist CurrentSince May 7, 2016 Accepting new patients
East Carolina University CurrentSince May 7, 2016 Accepting new patients

Locations

1161 N Road St
Elizabeth City, NC 27909
Phone (252) 331-7225

1851 Macgregor Downs Rd
Greenville, NC 27834
Phone (252) 737-7000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1104116565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11102 GLENN BROOK CT",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699200",
            "telephone_number": "301-928-3771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W BALTIMORE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011510",
            "telephone_number": "301-928-3771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "CAROL",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "10042",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "0126",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.