Healthcare Provider Details

I. General information

NPI: 1891204038
Provider Name (Legal Business Name): AMLAKIE DIGAFIE GEBEYEHU DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

10901 CHERRYVALE CT
BELTSVILLE MD
20705-3835
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-6000
  • Fax:
Mailing address:
  • Phone: 301-237-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR191567
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: