Provider Demographics
NPI:1043478480
Name:SABATH, CHARISSE ESTESS (MD)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:ESTESS
Last Name:SABATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARISSE
Other - Middle Name:
Other - Last Name:ESTESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6961 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6343
Mailing Address - Country:US
Mailing Address - Phone:240-354-5503
Mailing Address - Fax:
Practice Address - Street 1:5755 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2912
Practice Address - Country:US
Practice Address - Phone:410-720-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3201207R00000X
MDD72376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine