Provider Demographics
NPI:1235364001
Name:FAITH ESTERSON MD LLC
Entity Type:Organization
Organization Name:FAITH ESTERSON MD LLC
Other - Org Name:FAITH ESTERSON DERMATOLOGY AND SKIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:ESTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-602-3376
Mailing Address - Street 1:914 MONAGHAN CT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1529
Mailing Address - Country:US
Mailing Address - Phone:410-616-9330
Mailing Address - Fax:410-602-7954
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 340
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-602-3376
Practice Address - Fax:410-602-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50904207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
18BBMedicare PIN
F53351Medicare UPIN
070014328Medicare PIN