Provider Demographics
NPI:1356614655
Name:ZELEKE, BEMNET ZELEKE (PA-C)
Entity type:Individual
Prefix:MR
First Name:BEMNET
Middle Name:ZELEKE
Last Name:ZELEKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 OLD CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5036
Mailing Address - Country:US
Mailing Address - Phone:703-229-2094
Mailing Address - Fax:
Practice Address - Street 1:7 POST OFFICE RD # 7C
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2744
Practice Address - Country:US
Practice Address - Phone:301-645-8322
Practice Address - Fax:301-645-6229
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004705363A00000X
MDC04705363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant