MEDICARE: MR. CHARLES N. BETHMANN P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010207M14	MD

General Provider Information

NPI Number	:	1487655338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES N. BETHMANN P.A.-C

Provider Business Mailing Address
First Line	:	1111 BENFIELD BLVD
Second Line	:	SUITE 200
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-3002
Country	:	US
Telephone Number	:	410-729-5100
Fax Number	:	410-729-5156

Provider Business Practice Location Address
First Line	:	115 SALLITT DR
Second Line	:	SUITE E
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2156
Country	:	US
Telephone Number	:	410-643-7800
Fax Number	:	410-643-7568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/19/2011

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