Provider Demographics
NPI:1750384640
Name:ESTERSON, SAMUEL H (PT)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:H
Last Name:ESTERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W ROLLING CROSSROADS
Mailing Address - Street 2:STE 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-6204
Mailing Address - Country:US
Mailing Address - Phone:410-747-1600
Mailing Address - Fax:410-747-5202
Practice Address - Street 1:2 W ROLLING CROSSROADS
Practice Address - Street 2:STE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-6204
Practice Address - Country:US
Practice Address - Phone:410-747-1600
Practice Address - Fax:410-747-5202
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-10-03
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
MD14937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD342M467FMedicare ID - Type UnspecifiedMEDICARE INDIV PROV #
MDR12444Medicare UPIN