Provider Demographics
NPI:1881383065
Name:BEKELE, GIRMA
Entity type:Individual
Prefix:
First Name:GIRMA
Middle Name:
Last Name:BEKELE
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 1:3211 HOUR GLASS DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-6852
Mailing Address - Country:US
Mailing Address - Phone:720-492-9754
Mailing Address - Fax:
Practice Address - Street 1:3211 HOUR GLASS DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-6852
Practice Address - Country:US
Practice Address - Phone:720-492-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAE69641768172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver