Provider Demographics
NPI:1104947639
Name:KANKAM, JEMIMA (MD)
Entity type:Individual
Prefix:DR
First Name:JEMIMA
Middle Name:
Last Name:KANKAM
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 1:13639 BALTIMORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-604-4830
Mailing Address - Fax:301-604-4929
Practice Address - Street 1:13639 BALTIMORE AVENUE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5095
Practice Address - Country:US
Practice Address - Phone:301-604-4830
Practice Address - Fax:301-604-4929
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00305052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD430091200Medicaid
MDKL73JC38Medicare PIN
MDB70398Medicare UPIN
MD671009J91Medicare PIN