Provider Demographics
NPI:1275173866
Name:TILAHUN, MEKDES
Entity Type:Individual
Prefix:MRS
First Name:MEKDES
Middle Name:
Last Name:TILAHUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S BRAGG ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2793
Mailing Address - Country:US
Mailing Address - Phone:703-537-1062
Mailing Address - Fax:
Practice Address - Street 1:85 S BRAGG ST STE 200A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2793
Practice Address - Country:US
Practice Address - Phone:703-459-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-202233374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide