Provider Demographics
NPI:1285013417
Name:LIVINGSTON, CHARLES MICHAEL JR (AAHIVP, HIV PCP)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:LIVINGSTON
Suffix:JR
Gender:M
Credentials:AAHIVP, HIV PCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E LEXINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1732
Mailing Address - Country:US
Mailing Address - Phone:410-246-4877
Mailing Address - Fax:833-867-3017
Practice Address - Street 1:11 E LEXINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-1732
Practice Address - Country:US
Practice Address - Phone:410-246-4877
Practice Address - Fax:833-867-3017
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215642183500000X
GARPH027397183500000X
MD218751835P0018X, 183500000X
DCPH100002730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist