Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | D26357 | MD |
NPI | 1063472009 |
---|---|
Provider Name | Dr. Charles Jackson Vanmeter JR. |
First Address | Frederick, MD 21702-4301 |
Second Address | Frederick, MD 21702-4301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A1210001 | BSDC (01) | MD |
D74543 | (02) | |
KC81WA | BSMD (01) | MD |