Healthcare Provider Details

I. General information

NPI: 1588806616
Provider Name (Legal Business Name): JONATHAN RICHARD VAN METER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 W MAIN ST STE B
NEW MARKET MD
21774-6279
US

IV. Provider business mailing address

164 W MAIN ST STE B
NEW MARKET MD
21774-6279
US

V. Phone/Fax

Practice location:
  • Phone: 301-882-8470
  • Fax: 301-882-8471
Mailing address:
  • Phone: 301-882-8470
  • Fax: 301-882-8471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0075649
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: