Healthcare Provider Details

I. General information

NPI: 1114150067
Provider Name (Legal Business Name): MESELE ALEMU GEBREYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO ROAD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

4299 SAN FELIPE SUITE 300
HOUSTON TX
77027-2916
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-0620
  • Fax: 804-285-0726
Mailing address:
  • Phone: 832-476-3900
  • Fax: 832-476-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101246153
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101246153
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: