Healthcare Provider Details

I. General information

NPI: 1801679121
Provider Name (Legal Business Name): MESIRAK GEBRMARIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 FIDLER LN APT 513
SILVER SPRING MD
20910-7404
US

IV. Provider business mailing address

1203 FIDLER LN APT 513
SILVER SPRING MD
20910-7404
US

V. Phone/Fax

Practice location:
  • Phone: 202-820-3775
  • Fax:
Mailing address:
  • Phone: 202-820-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHHA200002886
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: