Provider Demographics
NPI:1063472009
Name:VANMETER, CHARLES JACKSON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JACKSON
Last Name:VANMETER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 THOMAS JOHNSON DR
Mailing Address - Street 2:STE A
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4301
Mailing Address - Country:US
Mailing Address - Phone:301-663-0400
Mailing Address - Fax:301-663-1906
Practice Address - Street 1:63 THOMAS JOHNSON DR
Practice Address - Street 2:STE A
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4301
Practice Address - Country:US
Practice Address - Phone:301-663-0400
Practice Address - Fax:301-663-1906
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26357207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKC81WAOtherBSMD
MDA1210001OtherBSDC
MD004M673EMedicare ID - Type Unspecified
MDKC81WAOtherBSMD