Provider Demographics
NPI:1538369830
Name:KAMANU ELIAS, NNEMDI (MD)
Entity type:Individual
Prefix:
First Name:NNEMDI
Middle Name:
Last Name:KAMANU ELIAS
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 1:2020 PENNSYLVANIA AVENUE NW #131
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-607-0864
Mailing Address - Fax:
Practice Address - Street 1:2020 PENNSYLVANIA AVE NW # 131
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1811
Practice Address - Country:US
Practice Address - Phone:202-607-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4454042083A0300X
DCMD0378612083A0300X
IAMD-502982083A0300X
VA01012511832083A0300X
MDD735182083A0300X
CAA75516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A755160Medicaid
CAH66309Medicare UPIN