Provider Demographics
NPI:1225455140
Name:GUDETA, ALEMESHET YAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEMESHET
Middle Name:YAMI
Last Name:GUDETA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7600 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6367
Practice Address - Country:US
Practice Address - Phone:301-891-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEMC0000517207R00000X
IL36154212207R00000X
DCMD044868207R00000X
COCDR0000847207R00000X
AZ61999207R00000X
ALMD41319207R00000X
VA0101261840207R00000X
MDD82810207R00000X
WI962320207R00000X
WAMD61100817207R00000X
UT119147351205207R00000X
TN62271207R00000X
PAMD469412207R00000X
NE32832207R00000X
MS28131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine