Healthcare Provider Details

I. General information

NPI: 1366619066
Provider Name (Legal Business Name): CHARLES P CIOLINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RESEARCH BLVD 350
ROCKVILLE MD
20850-3164
US

IV. Provider business mailing address

10229 HOLLY HILL PL
POTOMAC MD
20854-5025
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-9606
  • Fax: 301-838-9029
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD67570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: