Basic Information
| Provider Information | |||||||||
| NPI: | 1487655338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BETHMANN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 SALLITT DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | STEVENSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216662156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106437800 | ||||||||
| FaxNumber: | 4106437568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 01/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 010207M14 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.