MEDICARE: NICHOLAS ESSOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	08997	MD

General Provider Information

NPI Number	:	1134787971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ESSOCK

Provider Business Mailing Address
First Line	:	741 S LUZERNE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-3732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2921 STRANDEN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-2941
Country	:	US
Telephone Number	:	410-393-1406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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Directions to “ NICHOLAS ESSOCK ” Practice Location

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