Healthcare Provider Details

I. General information

NPI: 1689472227
Provider Name (Legal Business Name): PROF. MEBRAT BERHIE MEKONENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 BENCHMARK LN
BRISTOW VA
20136-5742
US

IV. Provider business mailing address

8855 BENCHMARK LN
BRISTOW VA
20136-5742
US

V. Phone/Fax

Practice location:
  • Phone: 202-344-6309
  • Fax:
Mailing address:
  • Phone: 202-344-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number791
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: