Healthcare Provider Details

I. General information

NPI: 1053087106
Provider Name (Legal Business Name): ZENATSEHAY BALCHA GEBRETSADIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 MCGAW RD STE 350-360
COLUMBIA MD
21045-4743
US

IV. Provider business mailing address

8890 MCGAW RD
COLUMBIA MD
21045-4743
US

V. Phone/Fax

Practice location:
  • Phone: 301-317-6575
  • Fax:
Mailing address:
  • Phone: 310-317-6575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR241343
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: