Healthcare Provider Details

I. General information

NPI: 1003376740
Provider Name (Legal Business Name): MELAT ABERRA GEBREMICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 EXECUTIVE BLVD
BETHESDA MD
20852-2219
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2219
US

V. Phone/Fax

Practice location:
  • Phone: 240-314-7080
  • Fax:
Mailing address:
  • Phone: 571-315-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD95880
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: