Provider Demographics
NPI:1619916087
Name:YOHANNES, GEBREMEDHIN (MD)
Entity Type:Individual
Prefix:MR
First Name:GEBREMEDHIN
Middle Name:
Last Name:YOHANNES
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 1:1500 FOREST GLEN RD
Mailing Address - Street 2:KAISER OFFICE
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1483
Mailing Address - Country:US
Mailing Address - Phone:703-359-7460
Mailing Address - Fax:301-754-7127
Practice Address - Street 1:1500 FOREST GLEN RD
Practice Address - Street 2:KAISER OFFICE
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1483
Practice Address - Country:US
Practice Address - Phone:703-359-7460
Practice Address - Fax:301-754-7127
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222995207R00000X
MDD55475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA184410OtherBCBS ANTHEM
VA496675OtherMDIPA OPTIMUM CHOICE
VA8505OtherKAISER PERMANENTE
VA010222265Medicaid
VA496675OtherMDIPA OPTIMUM CHOICE
VAH81649Medicare UPIN