Provider Demographics
NPI:1023016334
Name:LANCELOTTA JR., CHARLES JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:LANCELOTTA JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11085 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE LL-007
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2983
Mailing Address - Country:US
Mailing Address - Phone:410-715-2533
Mailing Address - Fax:410-715-2536
Practice Address - Street 1:11085 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE LL-007
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2983
Practice Address - Country:US
Practice Address - Phone:410-715-2533
Practice Address - Fax:410-715-2536
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0009071207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH687CHOtherBCBS MD
MD459950OtherAETNA
MD0600072OtherUNITED HEALTHCARE
MDJ9090001OtherBLUE CHOICE
MDC49367Medicare UPIN
MDJ9090001OtherBLUE CHOICE
MDH687CHOtherBCBS MD