Provider Demographics
NPI:1275306045
Name:AYALEW, KALKIDAN KASSAHUN (NP)
Entity Type:Individual
Prefix:
First Name:KALKIDAN
Middle Name:KASSAHUN
Last Name:AYALEW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 ALDERSHOT DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4155
Mailing Address - Country:US
Mailing Address - Phone:240-593-1017
Mailing Address - Fax:
Practice Address - Street 1:1307 VINCENT PL
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3680
Practice Address - Country:US
Practice Address - Phone:240-593-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2023100269363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health