Healthcare Provider Details

I. General information

NPI: 1609738707
Provider Name (Legal Business Name): ANDINET AYELE HAREGU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE STE 303
WASHINGTON DC
20020-7036
US

IV. Provider business mailing address

1702 HAMPSHIRE GREEN LN APT 14
SILVER SPRING MD
20903-2408
US

V. Phone/Fax

Practice location:
  • Phone: 202-889-7900
  • Fax: 202-610-3095
Mailing address:
  • Phone: 202-889-7900
  • Fax: 202-610-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: