Provider Demographics
NPI:1659544138
Name:ESSANDOH, EUGENE KOFI (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KOFI
Last Name:ESSANDOH
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 415816
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5816
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:25 CROSSROADS DR STE 110
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5444
Practice Address - Country:US
Practice Address - Phone:410-363-2192
Practice Address - Fax:410-363-2860
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34303207R00000X, 207RN0300X
ALMD343032085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I138933Medicare PIN