Healthcare Provider Details

I. General information

NPI: 1639126550
Provider Name (Legal Business Name): SARA S GEBREMICHAEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GREENBELT RD SUIT 101
LANHAM MD
20706-2273
US

IV. Provider business mailing address

9801 GREENBELT RD SUIT 101
LANHAM MD
20706-2273
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-6666
  • Fax: 301-552-6216
Mailing address:
  • Phone: 301-552-6666
  • Fax: 301-552-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD035167
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: