Provider Demographics
NPI:1184203044
Name:MAKONNEN, TIRSIT (MD, MHS)
Entity Type:Individual
Prefix:
First Name:TIRSIT
Middle Name:
Last Name:MAKONNEN
Suffix:
Gender:F
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 TOLEDO TER APT 711
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1338
Mailing Address - Country:US
Mailing Address - Phone:301-232-2549
Mailing Address - Fax:
Practice Address - Street 1:3450 TOLEDO TER APT 711
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1338
Practice Address - Country:US
Practice Address - Phone:301-232-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program