Provider Demographics
NPI:1922156579
Name:WORETA, DEREJE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREJE
Middle Name:
Last Name:WORETA
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12201 PLUM ORCHARD DRIVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7803
Practice Address - Country:US
Practice Address - Phone:301-572-3415
Practice Address - Fax:301-572-3398
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30444207R00000X
VA0101058619207R00000X
MDD0051963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
012627K92Medicare ID - Type Unspecified
G97760Medicare UPIN