Provider Demographics
NPI:1487687240
Name:ANNAPOLIS ENDOCRINOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ANNAPOLIS ENDOCRINOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTERO-LAKHANPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-571-7880
Mailing Address - Street 1:PO BOX 64131
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4131
Mailing Address - Country:US
Mailing Address - Phone:443-481-6526
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:12510 PROSPERITY DR
Practice Address - Street 2:SUITE 260
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1663
Practice Address - Country:US
Practice Address - Phone:301-592-8333
Practice Address - Fax:301-592-8336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53468207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G481OtherCAREFIRST
MD400734401Medicaid
KDY9ANOtherCAREFIRST
MD400734403Medicaid
1317379OtherAETNA HMO
MD400734401Medicaid
MD400734403Medicaid
MD400734401Medicaid