Provider Demographics
NPI:1669631909
Name:ERENA, ENDALKACHEW GMICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ENDALKACHEW
Middle Name:GMICHAEL
Last Name:ERENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4469 S FOUR MILE RUN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3501
Mailing Address - Country:US
Mailing Address - Phone:703-521-0490
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO ROAD
Practice Address - Street 2:2041 GEORGIA AVE NW
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:801-285-0620
Practice Address - Fax:804-285-0726
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101247789207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA113126Medicare PIN