Provider Demographics
NPI:1508000944
Name:HALCOME, CHARLES LANIER (IDMT, RMP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LANIER
Last Name:HALCOME
Suffix:
Gender:M
Credentials:IDMT, RMP
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:HALCOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 SOUTH GREEN STREET
Mailing Address - Street 2:T4M14 USAF CSTARS
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-328-7706
Mailing Address - Fax:410-328-7549
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:SUITE 300 RM 03-028
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-7706
Practice Address - Fax:410-328-7549
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P8021361146L00000X
1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic