Provider Demographics
NPI:1255023610
Name:GEBREMARIAM, TSEDAL ARAYA
Entity type:Individual
Prefix:
First Name:TSEDAL ARAYA
Middle Name:
Last Name:GEBREMARIAM
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 1:1400 E WEST HWY APT 414
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3238
Mailing Address - Country:US
Mailing Address - Phone:315-572-9327
Mailing Address - Fax:
Practice Address - Street 1:1400 E WEST HWY APT 414
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3238
Practice Address - Country:US
Practice Address - Phone:315-572-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00201407374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide