DR. CHARLES ABE ANDERSEN (NPI# 1639149479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639149479 |
| Entity Type | Individual |
| Full Name | DR. CHARLES ABE ANDERSEN |
| Practice Address |
9040 Jackson Ave Tacoma WA 98431-0001 |
| Mailing Address |
1302 28th Avenue Ct Milton WA 98354-7007 |
| Practice Telephone | 2539683885 |
| Practice Fax Number | 2539685997 |
| Mailing Telephone | 2539522135 |
| Mailing Fax Number | 2539528816 |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2020-08-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
151353-1205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
9040 JACKSON AVE |
| City | TACOMA |
| State | WA |
| Zip Code | 98431-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356345185 | John E Buonora | Nurse Anesthetist, Certified Registered | 9040 Jackson Ave, Tacoma, WA 98431-2025 | 2005-06-09 |
| 1629675251 | Brian Rankin | Student in an Organized Health Care Education/Training Program | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-10-06 |
| 1508473869 | Allyssa Lynn Borak | Student in an Organized Health Care Education/Training Program | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-09-30 |
| 1093322299 | Jessica Granger | Student in an Organized Health Care Education/Training Program | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-09-30 |
| 1134736481 | Rebecca Reinhardt | Student in an Organized Health Care Education/Training Program | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-09-29 |
| 1184238479 | Mark Nash | Physical Therapist | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-09-03 |
| 1679191969 | Christopher A Land | Student in an Organized Health Care Education/Training Program | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-07-13 |
| 1396362604 | Valerie Kruger | Genetic Counselor, MS | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-07-02 |
| 1255958724 | Michael Wong | Student in an Organized Health Care Education/Training Program | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-07-01 |
| 1841813391 | Kailey Utley | Optometrist | 9040 Jackson Ave, Tacoma, WA 98431-0001 | 2020-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1336695535 | Jacqueline D Massouda | Dentist | Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 | 2016-08-28 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
| Find all providers in zip 98431 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| 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 Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528097797 | Peter Kreishman | Surgery | 9040 Jackson Ave Vascular Surgery, Tacoma, WA 98431-0001 | 2006-07-01 |
| 1356346936 | James Gregory Roberts | Surgery | 1802 Yakima Ave, Ste 204, Tacoma, WA 98405-4499 | 2005-06-20 |
| 1760768402 | Franciscan Medical Group | Surgery | 1802 Yakima Ave, Ste 204, Tacoma, WA 98405-4499 | 2011-10-26 |
| 1578859575 | Sarah Elizabeth Koch | Surgery | 419 S L St, Tacoma, WA 98405-3799 | 2011-06-28 |
| 1598054413 | Jonathan Scott Ratcliff | Surgery | 419 S L St, Tacoma, WA 98405-3799 | 2011-03-31 |
| 1104050814 | Hao Trong Vu | Surgery | 1802 Yakima Ave Ste 204, Tacoma, WA 98405-5304 | 2009-05-08 |
| 1144346420 | Cascade Vascular Associates Ps | Surgery | 1802 S Yakima Ave, Ste 204a, Tacoma, WA 98405 | 2007-03-21 |
| 1750307369 | Todd K Kihara | Surgery | 1802 Yakima Ave, Suite 204, Tacoma, WA 98405-4499 | 2006-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710496922 | Sunnyside Community Hospital Association | Surgery | 1005 W Walnut St Ste 201, Yakima, WA 98902-3384 | 2017-09-20 |
| 1750762415 | Anna Ohlsson | Surgery | 325 9th Ave # 359908, Seattle, WA 98104-2420 | 2015-06-17 |
| 1356722938 | Usa Vascular Centers of Kent Pllc | Surgery | 26124a Pacific Hwy S Ste A, Kent, WA 98032-6910 | 2015-06-09 |
| 1154602084 | Memorial Physicians, Pllc | Surgery | 1812 E Edison Ave, Sunnyside, WA 98944-1653 | 2011-09-06 |
| 1528387941 | Sara Jane Wasilenko | Surgery | 128 Lilly Rd Ne Ste 205, Olympia, WA 98506-7400 | 2010-05-25 |
| 1801051404 | Franciscan Medical Group | Surgery | 710 S 348th St, Ste A, Federal Way, WA 98003-7042 | 2008-07-23 |
| 1013104165 | John S Arthur | Surgery | 2528 Wheaton Way Ste 101, Bremerton, WA 98310-3305 | 2007-10-02 |
| 1891986097 | Vascular Associates, Ps | Surgery | 801 Broadway Ste 522, Seattle, WA 98122-4325 | 2007-08-05 |
| 1447464730 | Mai Thanh Pham | Surgery | 1229 Madison St Suite # 1190, Seattle, WA 98104 | 2007-05-09 |
| 1649491481 | Dae Young Lee | Surgery | 1100 Goethals Drive 3rd Floor, Kadlec Clinic Vascular Surgery, Richland, WA 99352-3304 | 2007-05-01 |
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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.