NPIMap

Organization Active NPI

Charles J Supernavage, MD, PC

  • Otolaryngology Physician
  • Hagerstown, MD
National Provider Identifier
1639337405
Registry record updated May 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
D0026440 Issued in MD
Legal business name
CHARLES J SUPERNAVAGE, MD, PC
Practice address
201 S Cleveland Ave
Suite 403
Hagerstown, MD 21740-5745
Phone
(301) 739-0400
Fax
(301) 739-0402
NPI assigned
May 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. April C Evans, CMM
Title
Office Manager
Phone
(301) 739-0400

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X D0026440 MD Primary
AudiologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 231H00000X 00963 MD
Audiologist-Hearing Aid FitterGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 237600000X 00963 MD

Addresses

Primary practice location

201 S Cleveland Ave
Suite 403
Hagerstown, MD 21740-5745

Mailing address

201 S Cleveland Ave
Suite 403
Hagerstown, MD 21740-5745
Phone (301) 739-0400

Other identifiers 1

IdentifierTypeStateIssuer
314681200MedicaidMD

National Provider Directory

National Provider Directory

Locations

201 S Cleveland Ave
Ste 403
Hagerstown, MD 21740
Phone (301) 739-0400

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212019200000",
    "number": "1639337405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S CLEVELAND AVE",
            "address_2": "SUITE 403",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405745",
            "telephone_number": "301-739-0400",
            "fax_number": "301-739-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S CLEVELAND AVE",
            "address_2": "SUITE 403",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405745",
            "telephone_number": "301-739-0400",
            "fax_number": "301-739-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES J SUPERNAVAGE, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "301-739-0400",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CMM"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "MD",
            "license": "D0026440",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "MD",
            "license": "00963",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "MD",
            "license": "00963",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "314681200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.