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General NPI Number Information
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NPI Number | 1336604297
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Entity Type | Individual
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Provider Name | CHARLES BAYARD LARCOM IV MD
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Gender | Male
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431
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Country | US
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Telephone | 253-968-2462
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Fax | 253-968-2972
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Provider Business Mailing Address
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Address Line | 8901 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20889-5600
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Country | US
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Telephone | 12-954-1913
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Fax | 301-319-8751
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 74919-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 7491920
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 7491920
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 7491920
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License Number State | WI
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