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General NPI Number Information
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NPI Number | 1518272228
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Entity Type | Individual
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Provider Name | YOHANNES TESFALEM GEBREKIDAN M.D
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Gender | Male
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 2041 GEORGIA AVD NW # 1
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City | WASHINGTON
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State | DC
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Zip | 20060-0001
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Country | US
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Telephone | 716-348-2593
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Fax |
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Provider Business Mailing Address
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Address Line | 3139 UNIVERSITY BLVD W APT 2 C2
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City | KENSINGTON
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State | MD
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Zip | 20895-1814
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Country | US
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Telephone | 716-348-2593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0004378
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D91358
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License Number State | MD
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