Provider Demographics
NPI:1912561028
Name:GEDA, MENBERE A
Entity Type:Individual
Prefix:
First Name:MENBERE
Middle Name:A
Last Name:GEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 GARLAND AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7113
Mailing Address - Country:US
Mailing Address - Phone:202-509-6873
Mailing Address - Fax:
Practice Address - Street 1:8610 GARLAND AVE APT 301
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7113
Practice Address - Country:US
Practice Address - Phone:202-509-6873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14411374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide