Basic Information
| Provider Information | |||||||||
| NPI: | 1487687240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANNAPOLIS ENDOCRINOLOGY ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64131 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816526 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 12510 PROSPERITY DR | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209041663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015928333 | ||||||||
| FaxNumber: | 3015928336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 01/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | CANTERO-LAKHANPAL | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4105717880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | D53468 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | G481 | 01 | CAREFIRST | OTHER | 400734401 | 05 | MD | MEDICAID | KDY9AN | 01 | CAREFIRST | OTHER | 400734403 | 05 | MD | MEDICAID | 1317379 | 01 | AETNA HMO | OTHER |