Healthcare Provider Details

I. General information

NPI: 1811951049
Provider Name (Legal Business Name): JAMES M KIWANUKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 RUSSELL AVE
GAITHERSBURG MD
20879-3291
US

IV. Provider business mailing address

14302 TRILLIUM TER
SILVER SPRING MD
20906-2457
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-7891
  • Fax: 301-926-7892
Mailing address:
  • Phone: 301-603-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0027070
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: