Provider Demographics
NPI:1386675999
Name:MAURER, CHARLES LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEWIS
Last Name:MAURER
Suffix:
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 1:4501 EMPIRE COURT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408
Mailing Address - Country:US
Mailing Address - Phone:540-371-0079
Mailing Address - Fax:540-371-4254
Practice Address - Street 1:4501 EMPIRE COURT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408
Practice Address - Country:US
Practice Address - Phone:540-371-0079
Practice Address - Fax:540-371-4254
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225448207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005838215Medicaid
VAH17523Medicare UPIN
VA005838215Medicaid