Provider Demographics
NPI:1326006578
Name:ATNAFU, GEDION (MD)
Entity Type:Individual
Prefix:DR
First Name:GEDION
Middle Name:
Last Name:ATNAFU
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 1:7845 OAKWOOD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4256
Mailing Address - Country:US
Mailing Address - Phone:410-650-4100
Mailing Address - Fax:877-648-1188
Practice Address - Street 1:12701 TRUTHS PROMISE CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5600
Practice Address - Country:US
Practice Address - Phone:410-650-4100
Practice Address - Fax:877-648-1188
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062148207RI0200X
MDD62148208M00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD647076-01OtherBLUE CROSS/BLUE SHIELD
MD408456000Medicaid
MD647076-01OtherBLUE CROSS/BLUE SHIELD
MD408456000Medicaid