Provider Demographics
NPI:1316948508
Name:ESSANDOH, LOUIS K (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:K
Last Name:ESSANDOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62076
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2076
Mailing Address - Country:US
Mailing Address - Phone:410-280-6550
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3091
Practice Address - Country:US
Practice Address - Phone:410-897-9474
Practice Address - Fax:410-897-9476
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041417207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD081671000Medicaid
2238948OtherAETNA HMO
5026143OtherAETNA PPO
287094OtherMAMSI
081671000OtherAMERIGROUP
52386414OtherBCBS
0001OtherBCBS
060059880Medicare PIN
0001OtherBCBS
081671000OtherAMERIGROUP
P00633311Medicare PIN