Provider Demographics
NPI:1043099658
Name:CHARTER DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:CHARTER DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MENON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-693-3336
Mailing Address - Street 1:1800 LATIGO CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5507
Mailing Address - Country:US
Mailing Address - Phone:301-693-3336
Mailing Address - Fax:
Practice Address - Street 1:1008 TAVERN RD STE 201
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2859
Practice Address - Country:US
Practice Address - Phone:301-693-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty