Provider Demographics
NPI:1740616465
Name:ETZION, OHAD (MD)
Entity Type:Individual
Prefix:
First Name:OHAD
Middle Name:
Last Name:ETZION
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 1:331 CONGRESSIONAL LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1505
Mailing Address - Country:US
Mailing Address - Phone:240-669-3359
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DRIVE BLDG CLINICAL CTR RM 4-5722
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-451-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ34516284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital