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General NPI Number Information
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NPI Number | 1689748816
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Entity Type | Individual
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Provider Name | AGATON HOLAZO ESCALANTE MD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 3805 NORRISVILLE BOX 216
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City | JARRETTSVILLE
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State | MD
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Zip | 21084-1421
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Country | US
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Telephone | 410-557-9322
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Fax | 410-557-4451
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Provider Business Mailing Address
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Address Line | 308 LOCHVIEW TERRACE
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City | LUTHERVILLE
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State | MD
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Zip | 21093-2711
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Country | US
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Telephone | 410-557-9322
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Fax | 410-557-4451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0017679
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License Number State | MD
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