Basic Information
| Provider Information | |||||||||
| NPI: | 1205223039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIZAW | ||||||||
| FirstName: | MAHALET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 HOSPITAL DRIVE 5TH FLOOR | ||||||||
| Address2: | PRINCE GEORGE'S HOSPITAL CENTER DEPARTMENT OF MEDICINE | ||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016183776 | ||||||||
| FaxNumber: | 3016182986 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 HOSPITAL DRIVE | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016183776 | ||||||||
| FaxNumber: | 3016182986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.