Basic Information
| Provider Information | |||||||||
| NPI: | 1508000944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALCOME | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | LANIER | ||||||||
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| Credential: | IDMT, RMP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HALCOME | ||||||||
| OtherFirstName: | CHUCK | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 22 SOUTH GREEN STREET | ||||||||
| Address2: | T4M14 USAF CSTARS | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103287706 | ||||||||
| FaxNumber: | 4103287549 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 S PACA ST | ||||||||
| Address2: | SUITE 300 RM 03-028 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103287706 | ||||||||
| FaxNumber: | 4103287549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2009 | ||||||||
| LastUpdateDate: | 10/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146L00000X | P8021361 | N | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | 1710I1003X | Y | Other Service Providers | Military Health Care Provider | Independent Duty Medical Technicians |
No ID Information.