Provider Demographics
NPI:1669453973
Name:ENNIS, KHAMA D (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KHAMA
Middle Name:D
Last Name:ENNIS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:KHAMA
Other - Middle Name:D
Other - Last Name:ENNIS-HOLCOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:26 S PROSPECT ST STE 7
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2268
Mailing Address - Country:US
Mailing Address - Phone:413-800-6968
Mailing Address - Fax:
Practice Address - Street 1:150 INFIRMARY WAY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9288
Practice Address - Country:US
Practice Address - Phone:413-577-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223355207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine