Organization
CHARLES J SUPERNAVAGE, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. APRIL C EVANS CMM (OFFICE MANAGER)
(301) 739-0400
Entity
Organization
Contact information
Practice address
201 S CLEVELAND AVE, SUITE 403, HAGERSTOWN, MD 21740-5745
(301) 739-0400
(301) 739-0402
Mailing address
201 S CLEVELAND AVE, SUITE 403, HAGERSTOWN, MD 21740-5745
(301) 739-0400
(301) 739-0402
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
D0026440
MD
231H00000X
Audiologist
00963
MD
237600000X
Audiologist-Hearing Aid Fitter
00963
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314681200
—
MD
Enumeration date
05/29/2008
Last updated
05/29/2008
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