Provider Demographics
NPI:1023422540
Name:VELLENOWETH, CHARLOTTE ANNE (MD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANNE
Last Name:VELLENOWETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11551 NUCKOLS RD STE F
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5565
Mailing Address - Country:US
Mailing Address - Phone:804-364-4400
Mailing Address - Fax:803-364-0120
Practice Address - Street 1:11551 NUCKOLS RD STE F
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5565
Practice Address - Country:US
Practice Address - Phone:804-364-4400
Practice Address - Fax:803-364-0120
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL36994208000000X
VA0101262311208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics