Provider Demographics
NPI:1710242789
Name:BERAHO, LORRAINE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:BERAHO
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 TRAVILLE GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7409
Mailing Address - Country:US
Mailing Address - Phone:301-605-0692
Mailing Address - Fax:202-548-8600
Practice Address - Street 1:9740 TRAVILLE GATEWAY DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7409
Practice Address - Country:US
Practice Address - Phone:301-605-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116024926208000000X
CA156809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics