Provider Demographics
NPI:1508294364
Name:HABTEMARIAM, GELILA
Entity Type:Individual
Prefix:
First Name:GELILA
Middle Name:
Last Name:HABTEMARIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24655 NETTLE MILL SQ
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2993
Mailing Address - Country:US
Mailing Address - Phone:703-297-8139
Mailing Address - Fax:703-297-8139
Practice Address - Street 1:24655 NETTLE MILL SQ
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-2993
Practice Address - Country:US
Practice Address - Phone:703-297-8139
Practice Address - Fax:703-297-8139
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA287343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)