Healthcare Provider Details

I. General information

NPI: 1073573192
Provider Name (Legal Business Name): ABRAHAM GEBREMICHAEL P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GREENBELT RD STE 101
LANHAM MD
20706-6264
US

IV. Provider business mailing address

1904 AGATE DR
SILVER SPRING MD
20904-5301
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7000
  • Fax:
Mailing address:
  • Phone: 301-325-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: