Provider Demographics
NPI:1407911555
Name:HAMPTON BIPAT, KANIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:KANIKA
Middle Name:
Last Name:HAMPTON BIPAT
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20604-0549
Mailing Address - Country:US
Mailing Address - Phone:240-252-2150
Mailing Address - Fax:240-252-2151
Practice Address - Street 1:11315 PEMBROOKE SQ
Practice Address - Street 2:SUITE 111
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4806
Practice Address - Country:US
Practice Address - Phone:240-252-2150
Practice Address - Fax:240-252-2151
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine