Provider Demographics
NPI:1437213584
Name:BERHANE, LEAH (MD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:BERHANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 CLIFF PINE DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5704
Mailing Address - Country:US
Mailing Address - Phone:301-768-2992
Mailing Address - Fax:301-830-8310
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300 E
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-768-2992
Practice Address - Fax:801-289-9018
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD31623207V00000X
MDD0052801207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD65401900Medicaid
G77272Medicare UPIN