MEDICARE: BERHAN G HIDAR CNA

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	343900000X	Non-emergency Medical Transport (VAN)	B69697027	VA

General Provider Information

NPI Number	:	1669320149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERHAN G HIDAR CNA

Provider Business Mailing Address
First Line	:	1102 S HIGHLAND ST UNIT 1
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4481
Country	:	US
Telephone Number	:	202-294-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 S HIGHLAND ST UNIT 1
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4481
Country	:	US
Telephone Number	:	202-294-7888
Fax Number	:

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

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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