Provider Demographics
NPI:1558175083
Name:WOREDE, MELAT
Entity type:Individual
Prefix:
First Name:MELAT
Middle Name:
Last Name:WOREDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 VISTA HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2895
Mailing Address - Country:US
Mailing Address - Phone:404-644-8996
Mailing Address - Fax:
Practice Address - Street 1:10300 VISTA HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2895
Practice Address - Country:US
Practice Address - Phone:404-644-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN314610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner