MEDICARE: MRS. MEKDES TILAHUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HCO-202233	VA

General Provider Information

NPI Number	:	1275173866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEKDES TILAHUN

Provider Business Mailing Address
First Line	:	85 S BRAGG ST STE 200A
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2793
Country	:	US
Telephone Number	:	703-537-1062
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 S BRAGG ST STE 200A
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2793
Country	:	US
Telephone Number	:	703-459-5880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	02/29/2020

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