Basic Information
| Provider Information | |||||||||
| NPI: | 1053087106 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEBRETSADIK | ||||||||
| FirstName: | ZENATSEHAY | ||||||||
| MiddleName: | BALCHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2445 LYTTONSVILLE RD APT 1116 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209101935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405353120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 23RD ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200372342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027154000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2021 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | R241343 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.