Organization
ESOWOH HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDUL MALIK FOFANAH (MEDICAL DIRECTOR)
(240) 441-7536
Entity
Organization
Contact information
Practice address
2115 N CHARLES ST, BALTIMORE, MD 21218-5760
(301) 653-8255
Mailing address
2115 N CHARLES ST, BALTIMORE, MD 21218-5760
(301) 653-8255
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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