Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D0009071 | MD |
NPI | 1023016334 |
---|---|
Provider Name | Dr. Charles Joseph Lancelotta Jr. |
First Address | Columbia, MD 21044-2983 |
Second Address | Columbia, MD 21044-2983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0600072 | UNITED HEALTHCARE (01) | MD |
459950 | AETNA (01) | MD |
C49367 | (02) | MD |
H687CH | BCBS MD (01) | MD |
J9090001 | BLUE CHOICE (01) | MD |