Provider Demographics
NPI:1710068549
Name:GREENBELT MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:GREENBELT MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MESFIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBREMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-552-6666
Mailing Address - Street 1:203 LINTON KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1270
Mailing Address - Country:US
Mailing Address - Phone:301-552-6666
Mailing Address - Fax:
Practice Address - Street 1:9801 GREENBELT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2273
Practice Address - Country:US
Practice Address - Phone:301-552-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042354207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00174253OtherRAILROAD MEDICARE
MD5894029OtherAETNA
MD73153OtherAMERIGROUP
MDG469 0001OtherCAREFIRST
MD2102082OtherMAMSI
MD2102082OtherMAMSI
MDG469 0001OtherCAREFIRST