Provider Demographics
NPI:1366701112
Name:GHAM, MARIE-CHANTAL KWAKA
Entity type:Individual
Prefix:
First Name:MARIE-CHANTAL
Middle Name:KWAKA
Last Name:GHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15032 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5548
Mailing Address - Country:US
Mailing Address - Phone:202-644-1937
Mailing Address - Fax:
Practice Address - Street 1:15032 CHERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5548
Practice Address - Country:US
Practice Address - Phone:202-644-1937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide