Provider Demographics
NPI:1265116628
Name:WAINKEM, EDMOND
Entity type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:WAINKEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 DODGE PARK RD APT 104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2013
Mailing Address - Country:US
Mailing Address - Phone:484-326-7800
Mailing Address - Fax:
Practice Address - Street 1:3405 DODGE PARK RD APT 104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2013
Practice Address - Country:US
Practice Address - Phone:484-326-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator