Provider Demographics
NPI:1689905903
Name:KANJO, EMMANUEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:KANJO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 WATKINS STATION CIR
Mailing Address - Street 2:APT.F
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3345
Mailing Address - Country:US
Mailing Address - Phone:301-590-2633
Mailing Address - Fax:
Practice Address - Street 1:137 WATKINS STATION CIR
Practice Address - Street 2:APT.F
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3345
Practice Address - Country:US
Practice Address - Phone:301-590-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR128473367500000X
DCRN67916367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD031353000Medicaid
MD031353000Medicaid