MEDICARE: BEYENE EDO EDESSA

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R224494	MD

General Provider Information

NPI Number	:	1538016860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEYENE EDO EDESSA

Provider Business Mailing Address
First Line	:	607 HALIFAX PL
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-2158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 HALIFAX PL
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-2158
Country	:	US
Telephone Number	:	571-274-8291
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ BEYENE EDO EDESSA ” Practice Location

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