Provider Demographics
NPI:1659198729
Name:ABESSA, ZEKARIAS FEKADU
Entity type:Individual
Prefix:
First Name:ZEKARIAS
Middle Name:FEKADU
Last Name:ABESSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1860
Mailing Address - Country:US
Mailing Address - Phone:202-716-2612
Mailing Address - Fax:
Practice Address - Street 1:8140 HOLLOW CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1860
Practice Address - Country:US
Practice Address - Phone:202-716-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR251367363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty