| Esowoh Healthcare | |
|
2115 N Charles St Baltimore MD 21218-5760 | |
| (443) 869-4829 | |
| (443) 449-5651 |
| Full Name | Esowoh Healthcare |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2115 N Charles St, Baltimore, Maryland |
| Authorized Official Name and Position | Augustina Fofanah (CEO) |
| Authorized Official Contact | 2023040633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Esowoh Healthcare 2115 N Charles St Baltimore MD 21218-5760 Ph: (202) 304-0633 | Esowoh Healthcare 2115 N Charles St Baltimore MD 21218-5760 Ph: (443) 869-4829 |
| NPI Number | 1528826690 |
|---|---|
| Provider Enumeration Date | 03/12/2024 |
| Last Update Date | 06/12/2024 |
| Certification Date | 06/12/2024 |
| Medicare PECOS PAC ID | 5698218402 |
|---|---|
| Medicare Enrollment ID | O20240621001089 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528826690 | NPI | - | NPPES |
| Provider Name | Abdul Malik Fofanah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548979107 PECOS PAC ID: 6507309317 Enrollment ID: I20240621001232 |
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