Supernavage, Charles J

Supernavage, Charles J is an individual health care provider with primary practice located at 1800 Dual Hwy 303 , Hagerstown MD 21740-6648. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Supernavage, Charles J can be contacted via phone (301) 739-0400.

Contact Information

Primary practice address
1800 Dual Hwy 303 Hagerstown MD 21740-6648
Fax: (301) 739-0402
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X D0026440 Maryland

Profile Details

NPI number 1720080963
LBN Legal business name Supernavage, Charles J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2005
Last updated Aug 10th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720080963 NPPES
Maryland Other 36496001 CAREFIRST BLUE SHIELD ID
Maryland Other 770413 CAREFIRST BLUE SHIELD ID
Maryland MEDICAID 314681200 CAREFIRST BLUE SHIELD ID
Maryland Other 214080 CAREFIRST BLUE SHIELD ID

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