1508000944 NPI number — CHARLES LANIER HALCOME IDMT, RMP

Table of content: CHARLES LANIER HALCOME IDMT, RMP (NPI 1508000944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508000944 NPI number — CHARLES LANIER HALCOME IDMT, RMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALCOME
Provider First Name:
CHARLES
Provider Middle Name:
LANIER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IDMT, RMP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALCOME
Provider Other First Name:
CHUCK
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1508000944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 SOUTH GREEN STREET
Provider Second Line Business Mailing Address:
T4M14 USAF CSTARS
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-328-7706
Provider Business Mailing Address Fax Number:
410-328-7549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 S PACA ST
Provider Second Line Business Practice Location Address:
SUITE 300 RM 03-028
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-7706
Provider Business Practice Location Address Fax Number:
410-328-7549
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  P8021361 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1710I1003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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