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General NPI Number Information
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NPI Number | 1902942634
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Entity Type | Individual
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Provider Name | WELDEMARIAM MEZGHEBE P.A.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7600 CARROLL AVE
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City | TAKOMA PARK
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State | MD
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Zip | 20912-6367
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Country | US
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Telephone | 301-891-5447
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Fax |
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Provider Business Mailing Address
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Address Line | 12001 GORDON AVE
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City | BELTSVILLE
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State | MD
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Zip | 20705-1131
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Country | US
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Telephone | 301-937-6517
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C01669
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License Number State | MD
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