Healthcare Provider Details

I. General information

NPI: 1578483699
Provider Name (Legal Business Name): HAREGOT HAILE ZEROM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 HARTFELL RD
TIMONIUM MD
21093-2555
US

IV. Provider business mailing address

2424 HARTFELL RD
TIMONIUM MD
21093-2555
US

V. Phone/Fax

Practice location:
  • Phone: 443-858-3203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR232150
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: