Doctor Name: | MAKONNEN K. ZELLEKE |
NPI Number: | 1700873429 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | D0059191 |
Business Practice Address: | 7740 Gunston Plz Lorton, VA - 220791897 |
Business Phone Number: | 7033395858 |
Business Fax Number: | 7033395860 |
Mailing Address: | 7740 Gunston Plz, LORTON |
State: | VA |
Postal Code: | 220791897 |
Phone Number: | 7033395858 |
Fax Number: | 7033395860 |
NPI Enumeration Date: | 09/29/2005 |
NPI Last Update Date: | 05/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | D0059191 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |