Healthcare Provider Details

I. General information

NPI: 1588724009
Provider Name (Legal Business Name): MESKEREM ASRESAHEGN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MERCANTILE LN SUITE 180
LARGO MD
20774-5341
US

IV. Provider business mailing address

15905 WILLIS WAY
WOODBINE MD
21797-7521
US

V. Phone/Fax

Practice location:
  • Phone: 301-925-7022
  • Fax: 301-925-4463
Mailing address:
  • Phone: 301-704-7554
  • Fax: 301-925-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberD0053772
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: