Provider Demographics
NPI:1548558703
Name:GEBRU, MINAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:MINAS
Middle Name:W
Last Name:GEBRU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:201 DEFENSE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8943
Mailing Address - Country:US
Mailing Address - Phone:443-481-3354
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:443-481-1940
Practice Address - Fax:443-481-1941
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2017-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD820472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDX5810006OtherBCBS
MD202108100Medicaid
MD540139ZDWSMedicare PIN
MD202108100Medicaid