Provider Demographics
NPI:1295862712
Name:WOLDU, GEBREWAHID (MD)
Entity Type:Individual
Prefix:DR
First Name:GEBREWAHID
Middle Name:
Last Name:WOLDU
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE, MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:201 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-237-4000
Practice Address - Fax:703-536-1400
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039342207Q00000X
MDD0071547207Q00000X
VA0101231506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H52475Medicare UPIN
008646M92Medicare ID - Type Unspecified