Healthcare Provider Details

I. General information

NPI: 1356614655
Provider Name (Legal Business Name): BEMNET ZELEKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 POST OFFICE RD # 7C
WALDORF MD
20602-2744
US

IV. Provider business mailing address

6512 OLD CARRIAGE DR
ALEXANDRIA VA
22315-5036
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-8322
  • Fax: 301-645-6229
Mailing address:
  • Phone: 703-229-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC04705
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004705
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: