Provider Demographics
NPI:1245756907
Name:GEBREAMLAK, MEDHIN G (NP)
Entity Type:Individual
Prefix:
First Name:MEDHIN
Middle Name:G
Last Name:GEBREAMLAK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8072 HORSESHOE COTTAGE CIR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079
Mailing Address - Country:US
Mailing Address - Phone:703-732-7126
Mailing Address - Fax:
Practice Address - Street 1:8072 HORSESHOE COTTAGE CIR
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2327
Practice Address - Country:US
Practice Address - Phone:703-732-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002080363LP0808X, 363LF0000X
DC1024535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health