MEDICARE: DR. ETHIOPIA ABEBE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D40635	MD

General Provider Information

NPI Number	:	1588732580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ETHIOPIA ABEBE MD

Provider Business Mailing Address
First Line	:	2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNT
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-6666
Fax Number	:	301-816-6308

Provider Business Practice Location Address
First Line	:	5100 AUTH WAY
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-4207
Country	:	US
Telephone Number	:	301-702-5148
Fax Number	:	301-702-5116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	12/29/2021

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