Healthcare Provider Details

I. General information

NPI: 1235028689
Provider Name (Legal Business Name): MELAT BELAYNEH HAILEMARIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 OLD COLUMBIA PIKE
BURTONSVILLE MD
20866-1630
US

IV. Provider business mailing address

15 VALLEYFIELD CT
SILVER SPRING MD
20906-5723
US

V. Phone/Fax

Practice location:
  • Phone: 301-421-9060
  • Fax:
Mailing address:
  • Phone: 240-413-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0330135690
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30413
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: