Provider Demographics
NPI:1558624619
Name:GEBEREMARIAM, YONIS B (MD)
Entity Type:Individual
Prefix:DR
First Name:YONIS
Middle Name:B
Last Name:GEBEREMARIAM
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 1:5375 DUKE ST APT 1103
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3018
Mailing Address - Country:US
Mailing Address - Phone:720-366-3474
Mailing Address - Fax:
Practice Address - Street 1:5375 DUKE ST APT 1103
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3018
Practice Address - Country:US
Practice Address - Phone:720-366-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD79952207R00000X
VA0101258450207R00000X, 208M00000X
DC00000000000390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program