Healthcare Provider Details

I. General information

NPI: 1881397222
Provider Name (Legal Business Name): MAEDOT BISRAT TEKLEHIWOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10313 GEORGIA AVE STE 307
SILVER SPRING MD
20902-5006
US

IV. Provider business mailing address

8401 CONNECTICUT AVE PH SUITE
CHEVY CHASE MD
20815-5822
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-2222
  • Fax:
Mailing address:
  • Phone: 888-663-6331
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR231853
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR231853
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: