Provider Demographics
NPI:1033948690
Name:KOUMOULLIS, CHARALAMPOS (MD DDS MSC)
Entity type:Individual
Prefix:
First Name:CHARALAMPOS
Middle Name:
Last Name:KOUMOULLIS
Suffix:
Gender:M
Credentials:MD DDS MSC
Other - Prefix:
Other - First Name:HARIS
Other - Middle Name:
Other - Last Name:KOUMOULLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD DDS MSC
Mailing Address - Street 1:650 W BALTIMORE STREET
Mailing Address - Street 2:SUITE 1216
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-706-3964
Mailing Address - Fax:
Practice Address - Street 1:650 W BALTIMORE STREET
Practice Address - Street 2:SUITE 1216
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-706-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program