MEDICARE: SOPHIA KYEREMATEN CNM

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	367A00000X	Advanced Practice Midwife	R116128	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720172547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA KYEREMATEN CNM

Provider Business Mailing Address
First Line	:	3001 HOSPITAL DR
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1189
Country	:	US
Telephone Number	:	301-618-2355
Fax Number	:	301-618-3521

Provider Business Practice Location Address
First Line	:	7582 ANNAPOLIS RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-1744
Country	:	US
Telephone Number	:	301-618-1550
Fax Number	:	301-429-1873

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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