=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336846120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GENEVIEVE CHARTRAND MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2023
-----------------------------------------------------
Last Update Date | 08/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 MEDICAL PKWY STE 600
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-3748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-991-0080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2445 HOLLY AVE APT 612
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-4155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-991-0080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | R23199
-----------------------------------------------------
License Number State | ZZ
-----------------------------------------------------