Healthcare Provider Details

I. General information

NPI: 1750259552
Provider Name (Legal Business Name): CHARMAINE PFINAYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 DIAMOND DR
HAGERSTOWN MD
21740-5857
US

IV. Provider business mailing address

8224 GALLERY CT
GAITHERSBURG MD
20886-5618
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-1482
  • Fax:
Mailing address:
  • Phone: 240-364-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010215
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: