Provider Demographics
NPI:1467096438
Name:KIDANE, BETHEL TEWOLDE (PA -C)
Entity Type:Individual
Prefix:
First Name:BETHEL
Middle Name:TEWOLDE
Last Name:KIDANE
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 OLD COLUMBIA PIKE APT 808
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2554
Mailing Address - Country:US
Mailing Address - Phone:301-693-8629
Mailing Address - Fax:
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:301-693-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-03
Last Update Date:2022-08-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant