Active NPI
Jemima a. Kankam, M.D. P.a.
- Psychiatry Physician
- Laurel, MD
National Provider Identifier
1356463277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- D030505
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 339602900 | Medicaid | MD |
National Provider Directory
National Provider DirectoryLocations
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.