Provider Demographics
NPI:1710781158
Name:LANDERYOU, CHARLOTTE MCDERMOTT
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MCDERMOTT
Last Name:LANDERYOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 20TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1407
Mailing Address - Country:US
Mailing Address - Phone:413-687-4555
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE STE 1000
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5508
Practice Address - Country:US
Practice Address - Phone:609-677-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00090101367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife