Basic Information
| Provider Information | |||||||||
| NPI: | 1346436276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEKONNEN | ||||||||
| FirstName: | ERMIAS | ||||||||
| MiddleName: | AYTENFISU | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2041 GEORGIA AVE NW STE 6101 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028656679 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028656611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 0101256170 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 9374505-1205 | UT | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 390200000X | 149291 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084N0400X | MD040014 | DC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.