Provider Demographics
NPI:1689472227
Name:MEKONENE, MEBRAT BERHIE
Entity type:Individual
Prefix:PROF
First Name:MEBRAT
Middle Name:BERHIE
Last Name:MEKONENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 BENCHMARK LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-5742
Mailing Address - Country:US
Mailing Address - Phone:202-344-6309
Mailing Address - Fax:
Practice Address - Street 1:8855 BENCHMARK LN
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-5742
Practice Address - Country:US
Practice Address - Phone:202-344-6309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA791172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver