Healthcare Provider Details

I. General information

NPI: 1104407667
Provider Name (Legal Business Name): MEKLIT TESFAYE GEBRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST 210TH STREET MONTEFIORE MEDICAL CENTER
BRONX NY
10467
US

IV. Provider business mailing address

MONTEFIORE MEDICAL CENTER 111 EAST 210 STREET
BRONX NY
10467
US

V. Phone/Fax

Practice location:
  • Phone: 706-380-4685
  • Fax:
Mailing address:
  • Phone: 706-380-4685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number72055
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: