Healthcare Provider Details

I. General information

NPI: 1619817855
Provider Name (Legal Business Name): YIRGA MEKONNEN BIRHANU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 26TH ST NE
WASHINGTON DC
20018-2133
US

IV. Provider business mailing address

2714 26TH ST NE
WASHINGTON DC
20018-2133
US

V. Phone/Fax

Practice location:
  • Phone: 571-635-2853
  • Fax:
Mailing address:
  • Phone: 571-635-2853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00231054
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: