MEDICARE: EMMANUEL EKANEM M.D.

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	207R00000X	Internal Medicine Physician	0101259552	VA
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	0101259552	VA
3	207RC0000X	Cardiovascular Disease Physician	0101259552	VA

General Provider Information

NPI Number	:	1407274327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL EKANEM M.D.

Provider Business Mailing Address
First Line	:	220 CAMPUS BLVD STE 320
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2889
Country	:	US
Telephone Number	:	540-536-5100
Fax Number	:	540-536-0235

Provider Business Practice Location Address
First Line	:	1880 AMHERST STREET
Second Line	:	SUITE 100 AND SUITE 200
City	:	WINCHESTER
State	:	VA
Zip	:	22601
Country	:	US
Telephone Number	:	540-662-0306
Fax Number	:	855-264-2066

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

Provider Enumeration Date	:	03/29/2014
Last Update Date	:	03/02/2026

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