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General NPI Number Information
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NPI Number | 1902075997
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Entity Type | Organization
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Legal Business Name | CHARLES J. LANCELOTTA JR., M.D., P.A.
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 02/25/2008
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Provider Practice Location Address
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Address Line | 11055 LITTLE PATUXENT PKWY SUITE L7
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City | COLUMBIA
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State | MD
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Zip | 21044-2896
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Country | US
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Telephone | 410-715-2533
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Fax | 410-715-2536
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Provider Business Mailing Address
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Address Line | 11085 LITTLE PATUXENT PKWY SUITE LL-007
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City | COLUMBIA
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State | MD
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Zip | 21044-2983
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Country | US
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Telephone | 410-715-2533
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Fax | 410-715-2536
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES JOSEPH LANCELOTTA JR.
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Credential | M.D.
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Telephone | 410-715-2533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0009071
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License Number State | MD
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