Healthcare Provider Details

I. General information

NPI: 1568527430
Provider Name (Legal Business Name): LEOMINA D ESCALANTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 MERRITT BLVD SUITE 13
BALTIMORE MD
21222-2132
US

IV. Provider business mailing address

1576 MERRITT BLVD SUITE 13
BALTIMORE MD
21222-2132
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-4403
  • Fax: 410-282-2508
Mailing address:
  • Phone: 410-282-4403
  • Fax: 410-282-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0018869
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: