Provider Demographics
NPI:1427550797
Name:HAGOS, KALKIDAN ARAYA
Entity Type:Individual
Prefix:MRS
First Name:KALKIDAN
Middle Name:ARAYA
Last Name:HAGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KALKIDAN
Other - Middle Name:ARAYA
Other - Last Name:HAGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 SHERIDAN ST APT 511
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3210
Mailing Address - Country:US
Mailing Address - Phone:240-423-1792
Mailing Address - Fax:
Practice Address - Street 1:620 SHERIDAN ST APT 511
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3210
Practice Address - Country:US
Practice Address - Phone:240-423-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13356374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide