Healthcare Provider Details

I. General information

NPI: 1902769789
Provider Name (Legal Business Name): MERON TARIKU MAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 ELLSWORTH HEIGHTS ST
SILVER SPRING MD
20910-4315
US

IV. Provider business mailing address

28 ELLSWORTH HEIGHTS ST
SILVER SPRING MD
20910-4315
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-3233
  • Fax:
Mailing address:
  • Phone: 301-673-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0901X
TaxonomyDiplomate Laboratory Management Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: