Basic Information
| Provider Information | |||||||||
| NPI: | 1427146117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEBREMEDHIN | ||||||||
| FirstName: | MULUGETA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 FIRST COLONIAL RD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234543002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573952323 | ||||||||
| FaxNumber: | 7573956280 | ||||||||
| Practice Location | |||||||||
| Address1: | 1060 FIRST COLONIAL RD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234543002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573952323 | ||||||||
| FaxNumber: | 7573956280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0101240188 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101240188 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.