Healthcare Provider Details

I. General information

NPI: 1093706871
Provider Name (Legal Business Name): MAHETEME BAYEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GREENBELT RD SUITE 101
LANHAM MD
20706-2273
US

IV. Provider business mailing address

PO BOX 10823
SILVER SPRING MD
20914-0823
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 Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0054579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: