MEDICARE: EDMOND WAINKEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1265116628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMOND WAINKEM

Provider Business Mailing Address
First Line	:	3405 DODGE PARK RD APT 104
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-2013
Country	:	US
Telephone Number	:	484-326-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 DODGE PARK RD APT 104
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-2013
Country	:	US
Telephone Number	:	484-326-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/02/2026

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Directions to “ EDMOND WAINKEM ” Practice Location

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