Provider Demographics
NPI:1679503064
Name:MEKLIT WORKNEH,MD, PA
Entity Type:Organization
Organization Name:MEKLIT WORKNEH,MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MEKLIT
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKNEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-1371
Mailing Address - Street 1:13305 BIG CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5609
Mailing Address - Country:US
Mailing Address - Phone:301-860-1195
Mailing Address - Fax:301-220-1372
Practice Address - Street 1:7705 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3300
Practice Address - Country:US
Practice Address - Phone:301-220-1371
Practice Address - Fax:301-220-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491893Medicare ID - Type Unspecified
MDI23494Medicare UPIN