Organization
OUTREACH RECOVERY II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISIAH COLES (COO)
(561) 502-3978
Entity
Organization
Contact information
Practice address
222 N CHARLES ST STE 101B, BALTIMORE, MD 21201-4032
(410) 800-4466
Mailing address
4201 NORTHVIEW DR STE 104, BOWIE, MD 20716-2655
(410) 800-4466
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100170888
—
MD
Enumeration date
03/10/2021
Last updated
03/10/2021
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