Healthcare Provider Details

I. General information

NPI: 1952980245
Provider Name (Legal Business Name): EMNET YIBELTAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 ANNAPOLIS RD
LANDOVER HILLS MD
20784-1307
US

IV. Provider business mailing address

1631 11TH ST UNIT B
WICHITA FALLS TX
76301-4332
US

V. Phone/Fax

Practice location:
  • Phone: 301-276-3377
  • Fax:
Mailing address:
  • Phone: 940-263-3000
  • Fax: 940-263-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV2344
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0102051
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: