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General NPI Number Information
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NPI Number | 1144128877
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Entity Type | Individual
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Provider Name | GERVAIS NEMBOT KAMDEM
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Gender | Male
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Dates
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Enumeration Date | 10/31/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 4004 ERDMAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21213-2042
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Country | US
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Telephone | 410-498-4643
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Fax | 410-498-4612
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Provider Business Mailing Address
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Address Line | 4709 HARFORD RD # 66
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City | BALTIMORE
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State | MD
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Zip | 21214-3205
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Country | US
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Telephone | 410-498-4643
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Fax | 410-498-4612
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | W27733757
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License Number State | MD
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