Provider Demographics
NPI:1477129617
Name:KHAMISHON, REBECCA ESTHER (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ESTHER
Last Name:KHAMISHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N CAROLINE ST # 5064
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0006
Mailing Address - Country:US
Mailing Address - Phone:410-502-0133
Mailing Address - Fax:410-502-6737
Practice Address - Street 1:601 N CAROLINE ST # 5064
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-502-0133
Practice Address - Fax:410-502-6737
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD01036292084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program