Provider Demographics
NPI:1871101188
Name:BERHE, YONATAN BEYENE
Entity type:Individual
Prefix:
First Name:YONATAN
Middle Name:BEYENE
Last Name:BERHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 S GEORGE MASON DR APT 710W
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3267
Mailing Address - Country:US
Mailing Address - Phone:240-707-9577
Mailing Address - Fax:
Practice Address - Street 1:3713 S GEORGE MASON DR APT 710W
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3267
Practice Address - Country:US
Practice Address - Phone:240-707-9577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver