Provider Demographics
NPI:1326033952
Name:QUAINOO, EBENEZER KOBINA (MD)
Entity Type:Individual
Prefix:DR
First Name:EBENEZER
Middle Name:KOBINA
Last Name:QUAINOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21068
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-0568
Mailing Address - Country:US
Mailing Address - Phone:410-368-8317
Mailing Address - Fax:410-368-8319
Practice Address - Street 1:3350 WILKENS AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4600
Practice Address - Country:US
Practice Address - Phone:410-368-8317
Practice Address - Fax:410-368-8319
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO61765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405216100Medicaid
MD4147675503Medicaid
MD327PMedicare PIN
MD4147675503Medicaid
MD405216100Medicaid