Provider Demographics
NPI:1821393919
Name:CLINICAL OUTCOME IMPROVEMENT MEDICINE, LLC
Entity type:Organization
Organization Name:CLINICAL OUTCOME IMPROVEMENT MEDICINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-869-3344
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-0257
Mailing Address - Country:US
Mailing Address - Phone:410-869-3344
Mailing Address - Fax:410-869-3340
Practice Address - Street 1:4 E ROLLING CROSSROADS
Practice Address - Street 2:SUITE 102
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6210
Practice Address - Country:US
Practice Address - Phone:410-869-3344
Practice Address - Fax:410-869-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6186Medicare PIN