Provider Demographics
NPI:1871786087
Name:CRM DERMATOLOGY, L.L.C.
Entity type:Organization
Organization Name:CRM DERMATOLOGY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CIRO
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-532-7546
Mailing Address - Street 1:2 VILLAGE SQUARE
Mailing Address - Street 2:SUITE# 260
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1935
Mailing Address - Country:US
Mailing Address - Phone:410-532-7546
Mailing Address - Fax:410-532-7553
Practice Address - Street 1:2 VILLAGE SQUARE
Practice Address - Street 2:THE VILLAGE OF CROSS KEYS, SUITE # 260
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1935
Practice Address - Country:US
Practice Address - Phone:410-532-7546
Practice Address - Fax:410-532-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051794261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H766JOMedicare PIN