Healthcare Provider Details

I. General information

NPI: 1710054598
Provider Name (Legal Business Name): DIEGO ANTHONY ESCOBOSA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 DEFENSE HWY STE 213
ANNAPOLIS MD
21401-8907
US

IV. Provider business mailing address

133 DEFENSE HWY STE 213
ANNAPOLIS MD
21401-8907
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-7667
  • Fax: 410-224-7007
Mailing address:
  • Phone: 443-699-0156
  • Fax: 410-703-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0043930
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: