Healthcare Provider Details

I. General information

NPI: 1679503064
Provider Name (Legal Business Name): MEKLIT WORKNEH,MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7705 BELLE POINT DR
GREENBELT MD
20770-3300
US

IV. Provider business mailing address

13305 BIG CEDAR LN
BOWIE MD
20720-5609
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-1371
  • Fax: 301-220-1372
Mailing address:
  • Phone: 301-860-1195
  • Fax: 301-220-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0062116
License Number StateMD

VIII. Authorized Official

Name: MEKLIT WORKNEH
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 301-220-1371