Provider Demographics
NPI:1497220826
Name:LANPHEAR, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:LANPHEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 PRIMROSE CT APT 304
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-5151
Mailing Address - Country:US
Mailing Address - Phone:410-956-7777
Mailing Address - Fax:
Practice Address - Street 1:3168 BRAVERTON ST.
Practice Address - Street 2:#340
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037
Practice Address - Country:US
Practice Address - Phone:410-956-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06986363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical