Healthcare Provider Details

I. General information

NPI: 1134480858
Provider Name (Legal Business Name): FASIKA BERHANU ABERRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL RD STE 300
PRINCE FREDERICK MD
20678-4057
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4333
  • Fax: 410-535-3260
Mailing address:
  • Phone: 540-564-5800
  • Fax: 833-552-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51366
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD96613
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51366
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101266585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: