Basic Information
| Provider Information | |||||||||
| NPI: | 1780683813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTERO-LAKHANPAL | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CANTERO | ||||||||
| OtherFirstName: | JOAN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 64131 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816480 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 FORBES ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214011502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105717880 | ||||||||
| FaxNumber: | 4105710362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 10/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | D0053468 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 3072419 | 01 | AETNA HMO | OTHER | 60604405 | 01 | CAREFIRST | OTHER | 5495620 | 01 | AETNA PPO | OTHER | 60604407 | 01 | CAREFIRST | OTHER | 60604408 | 01 | CAREFIRST | OTHER | 60604410 | 01 | CAREFIRST | OTHER | 0001 | 01 | CAREFIRST | OTHER | 300340 | 01 | UHC | OTHER | 400734404129917400 | 05 | MD | MEDICAID | 60604406 | 01 | CAREFIRST | OTHER | 60604409 | 01 | CAREFIRST | OTHER |