Provider Demographics
NPI:1558331074
Name:ANNAPOLIS ENDOCRINOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ANNAPOLIS ENDOCRINOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
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 1:108 FORBES ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1502
Practice Address - Country:US
Practice Address - Phone:410-571-7880
Practice Address - Fax:410-571-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400734402Medicaid
MD400734400Medicaid
MD400734403Medicaid
3072906OtherAETNA HMO
7651410OtherAETNA PPO
KDY9ANOtherCAREFIRST
MD400734401Medicaid
G481OtherCAREFIRST
=========002OtherTRICARE/HEALTH NET
G481OtherCAREFIRST
KDY9ANOtherCAREFIRST
=========OtherAMERICHOICE
MD400734402Medicaid
MD400734403Medicaid
MD400734401Medicaid
G02436Medicare PIN