MEDICARE: DR. JONATHAN RICHARD VAN METER M.D.

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	207N00000X	Dermatology Physician	D0075649	MD
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1588806616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN RICHARD VAN METER M.D.

Provider Business Mailing Address
First Line	:	164 W MAIN ST STE B
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6279
Country	:	US
Telephone Number	:	301-882-8470
Fax Number	:	301-882-8471

Provider Business Practice Location Address
First Line	:	164 W MAIN ST STE B
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6279
Country	:	US
Telephone Number	:	301-882-8470
Fax Number	:	301-882-8471

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	03/09/2026

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