Individual
DR. CHARLES J SUPERNAVAGE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 DUAL HWY 303, HAGERSTOWN, MD 21740-6648
(301) 739-0400
(301) 739-0402
Mailing address
1800 DUAL HIGHWAY, SUITE 303, HAGERSTOWN, MD 21740-6602
(301) 739-0400
(301) 739-0402
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
D0026440
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214080
MAMSI ID #
MD
05
—
314681200
—
MD
01
—
36496001
CAREFIRST BLUE SHIELD ID
MD
01
—
770413
AETNA ID #
—
Enumeration date
06/01/2005
Last updated
08/10/2015
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