Healthcare Provider Details

I. General information

NPI: 1396935763
Provider Name (Legal Business Name): MELAKU GEBREMARIAM DEMEDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 CARRIAGE DR
BECKLEY WV
25801-2805
US

IV. Provider business mailing address

427 CARRIAGE DR
BECKLEY WV
25801-2805
US

V. Phone/Fax

Practice location:
  • Phone: 304-241-2796
  • Fax: 681-207-1811
Mailing address:
  • Phone: 304-241-2796
  • Fax: 681-207-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number24891
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: