Healthcare Provider Details

I. General information

NPI: 1215139191
Provider Name (Legal Business Name): ASSEFA GEBRESELASSIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE PROVIDENCE HOSPITAL NURSERY
WASHINGTON DC
20017-2149
US

IV. Provider business mailing address

10506 GROSVENOR PL
ROCKVILLE MD
20852-4665
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-7000
  • Fax:
Mailing address:
  • Phone: 301-379-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD15778
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: