Provider Demographics
NPI:1780437624
Name:ABEBE, MALACHI
Entity type:Individual
Prefix:
First Name:MALACHI
Middle Name:
Last Name:ABEBE
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 1:3123 HAWTHORNE DR NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1040
Mailing Address - Country:US
Mailing Address - Phone:402-904-2738
Mailing Address - Fax:
Practice Address - Street 1:520 W ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-1021
Practice Address - Country:US
Practice Address - Phone:202-806-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program