Healthcare Provider Details

I. General information

NPI: 1316948508
Provider Name (Legal Business Name): LOUIS K ESSANDOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 BESTGATE RD SUITE 211
ANNAPOLIS MD
21401-3091
US

IV. Provider business mailing address

PO BOX 62076
BALTIMORE MD
21264-2076
US

V. Phone/Fax

Practice location:
  • Phone: 410-897-9474
  • Fax: 410-897-9476
Mailing address:
  • Phone: 410-280-6550
  • Fax: 410-280-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0041417
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: