Provider Demographics
NPI:1235891391
Name:GEBREKIDAN, ZELALEM T (RN)
Entity Type:Individual
Prefix:PROF
First Name:ZELALEM
Middle Name:T
Last Name:GEBREKIDAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3108 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6858
Mailing Address - Country:US
Mailing Address - Phone:202-341-2396
Mailing Address - Fax:
Practice Address - Street 1:6120 KANSAS AVE. , NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-829-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN1011249207RC0200X
DCRN1011249207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine