Provider Demographics
NPI:1518272228
Name:GEBREKIDAN, YOHANNES TESFALEM (MD)
Entity Type:Individual
Prefix:DR
First Name:YOHANNES
Middle Name:TESFALEM
Last Name:GEBREKIDAN
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 1:3139 UNIVERSITY BLVD W APT 2
Mailing Address - Street 2:C2
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1814
Mailing Address - Country:US
Mailing Address - Phone:716-348-2593
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVD NW # 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:716-348-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004378363A00000X
MDD91358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant