Provider Demographics
NPI:1700826120
Name:MAKONNEN, ZELALEM (MD)
Entity Type:Individual
Prefix:DR
First Name:ZELALEM
Middle Name:
Last Name:MAKONNEN
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 1:4539 MAXFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3529
Mailing Address - Country:US
Mailing Address - Phone:703-941-8728
Mailing Address - Fax:
Practice Address - Street 1:2200 KERNAN DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-6665
Practice Address - Country:US
Practice Address - Phone:301-652-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058009208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404309000Medicaid
MD019MM205Medicare ID - Type Unspecified
MD404309000Medicaid