Healthcare Provider Details

I. General information

NPI: 1346436276
Provider Name (Legal Business Name): ERMIAS AYTENFISU MEKONNEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1497
US

IV. Provider business mailing address

2041 GEORGIA AVE NW STE 6101
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-3100
  • Fax:
Mailing address:
  • Phone: 202-865-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9374505-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101256170
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0086800
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2025013771
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number104198
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1471653
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberT2216
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD040014
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: