Basic Information
| Provider Information | |||||||||
| NPI: | 1619916087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOHANNES | ||||||||
| FirstName: | GEBREMEDHIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 FOREST GLEN RD | ||||||||
| Address2: | KAISER OFFICE | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209101483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033597460 | ||||||||
| FaxNumber: | 3017547127 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 FOREST GLEN RD | ||||||||
| Address2: | KAISER OFFICE | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209101483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033597460 | ||||||||
| FaxNumber: | 3017547127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101222995 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D55475 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 184410 | 01 | VA | BCBS ANTHEM | OTHER | 496675 | 01 | VA | MDIPA OPTIMUM CHOICE | OTHER | 8505 | 01 | VA | KAISER PERMANENTE | OTHER | 010222265 | 05 | VA | MEDICAID |