Provider Demographics
NPI:1790985877
Name:ESANAKULA, SWARUPA RANI (MD)
Entity Type:Individual
Prefix:
First Name:SWARUPA
Middle Name:RANI
Last Name:ESANAKULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 WESTERLEE PL
Mailing Address - Street 2:APT 1D
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3873
Mailing Address - Country:US
Mailing Address - Phone:410-788-0333
Mailing Address - Fax:410-788-0333
Practice Address - Street 1:1208 WESTERLEE PL
Practice Address - Street 2:APT 1D
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3873
Practice Address - Country:US
Practice Address - Phone:410-788-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067617207RG0300X
VA0101243596207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA169778ZCALMedicare PIN
MDH330Medicare PIN