Provider Demographics
NPI:1689748816
Name:ESCALANTE, AGATON HOLAZO (MD)
Entity Type:Individual
Prefix:DR
First Name:AGATON
Middle Name:HOLAZO
Last Name:ESCALANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:308 LOCHVIEW TERRACE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2711
Mailing Address - Country:US
Mailing Address - Phone:410-557-9322
Mailing Address - Fax:410-557-4451
Practice Address - Street 1:3805 NORRISVILLE
Practice Address - Street 2:BOX 216
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1421
Practice Address - Country:US
Practice Address - Phone:410-557-9322
Practice Address - Fax:410-557-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD398861901Medicaid
MD31060005OtherBCBS
0163901OtherUNITED HEALTHCARE
041673OtherUS HEALTHCARE
MD110011897OtherMEDICARE RAILROAD
660461156OtherAETNA
660461156OtherAETNA
MD398861901Medicaid