Provider Demographics
NPI:1376364497
Name:DEREJE, MELAT
Entity type:Individual
Prefix:
First Name:MELAT
Middle Name:
Last Name:DEREJE
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 1:14310 BRADSHAW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-6505
Mailing Address - Country:US
Mailing Address - Phone:202-617-5589
Mailing Address - Fax:
Practice Address - Street 1:14310 BRADSHAW DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-6505
Practice Address - Country:US
Practice Address - Phone:202-617-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant