Organization Active NPI

Jemima a. Kankam, M.D. P.a.

  • Psychiatry Physician
  • Laurel, MD
National Provider Identifier
1356463277
Registry record updated May 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
D030505 Issued in MD
Legal business name
JEMIMA A. KANKAM, M.D. P.A.
Practice address
13639 Baltimore Avenue
Laurel, MD 20707-5095
Phone
(301) 604-4830
Fax
(301) 604-4929
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jemima Kankam, M.D.
Title
President
Phone
(301) 604-4830

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X D030505 MD Primary

Addresses

Primary practice location

13639 Baltimore Avenue
Laurel, MD 20707-5095

Mailing address

13639 Baltimore Avenue
Laurel, MD 20707-5095
Phone (301) 604-4830

Other identifiers 1

IdentifierTypeStateIssuer
339602900MedicaidMD

National Provider Directory

National Provider Directory

Locations

7310 Ritchie Hwy
Ste 406
Glen Burnie, MD 21061
Phone (240) 517-2650

13639 Baltimore Ave
Laurel, MD 20707
Phone (301) 604-4830

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337644800000",
    "number": "1356463277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13639 BALTIMORE AVENUE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075095",
            "telephone_number": "301-604-4830",
            "fax_number": "301-604-4929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13639 BALTIMORE AVENUE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075095",
            "telephone_number": "301-604-4830",
            "fax_number": "301-604-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEMIMA A. KANKAM, M.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2012-05-22",
        "status": "A",
        "authorized_official_last_name": "KANKAM",
        "authorized_official_first_name": "JEMIMA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-604-4830",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D030505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "339602900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.