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General NPI Number Information
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NPI Number | 1225955545
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Entity Type | Individual
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Provider Name | KENNEDI WICKHAM
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Gender | Female
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 12200 ANNAPOLIS RD STE 315
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City | GLENN DALE
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State | MD
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Zip | 20769-9182
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Country | US
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Telephone | 301-249-0970
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Fax |
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Provider Business Mailing Address
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Address Line | 13917 ROCKINGHAM RD
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City | GERMANTOWN
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State | MD
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Zip | 20874-2230
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Country | US
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Telephone |
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | C0010599
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License Number State | MD
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