NPIMap

Individual provider Active NPI

Charles J Supernavage, MD

  • Otolaryngology Physician
  • Hagerstown, MD
National Provider Identifier
1720080963
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
D0026440 Issued in MD
Practice address
1800 Dual Hwy 303
Hagerstown, MD 21740-6648
Phone
(301) 739-0400
Fax
(301) 739-0402
NPI assigned
Jun 1, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X D0026440 MD Primary

Addresses

Primary practice location

1800 Dual Hwy 303
Hagerstown, MD 21740-6648

Mailing address

1800 Dual Highway
Suite 303
Hagerstown, MD 21740-6602
Phone (301) 739-0400

Other identifiers 4

IdentifierTypeStateIssuer
770413OtherAETNA ID #
214080OtherMDMAMSI ID #
314681200MedicaidMD
36496001OtherMDCAREFIRST BLUE SHIELD ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0026440MDMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central ENT Consultants, PC Otolaryngology Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JFABCD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1720080963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 DUAL HIGHWAY",
            "address_2": "SUITE 303",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406602",
            "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": "1800 DUAL HWY 303",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406648",
            "telephone_number": "301-739-0400",
            "fax_number": "301-739-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERNAVAGE",
        "first_name": "CHARLES",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MD",
            "license": "D0026440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID #",
            "identifier": "770413",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI ID #",
            "identifier": "214080",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "314681200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE SHIELD ID",
            "identifier": "36496001",
            "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 Jul 13, 2026; 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.