Provider Demographics
NPI:1831833631
Name:MAMO, KALKIDAN
Entity type:Individual
Prefix:DR
First Name:KALKIDAN
Middle Name:
Last Name:MAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALKIDAN
Other - Middle Name:
Other - Last Name:MAMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3701 S GEORGE MASON DR UNIT 212N
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3776
Mailing Address - Country:US
Mailing Address - Phone:240-784-6745
Mailing Address - Fax:
Practice Address - Street 1:10141 COLESVILLE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2457
Practice Address - Country:US
Practice Address - Phone:301-593-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist