Healthcare Provider Details

I. General information

NPI: 1881499820
Provider Name (Legal Business Name): ZEWIDU BELAY MEKONEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14427 INNSBRUCK CT
SILVER SPRING MD
20906-2256
US

IV. Provider business mailing address

14427 INNSBRUCK CT
SILVER SPRING MD
20906-2256
US

V. Phone/Fax

Practice location:
  • Phone: 240-438-1462
  • Fax:
Mailing address:
  • Phone: 240-438-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberMD10275221216
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: