Healthcare Provider Details

I. General information

NPI: 1578732665
Provider Name (Legal Business Name): GIFTY AFETA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 COLONIAL LN
SILVER SPRING MD
20910-5721
US

IV. Provider business mailing address

8630 FENTON ST STE 1204
SILVER SPRING MD
20910-3806
US

V. Phone/Fax

Practice location:
  • Phone: 301-586-1250
  • Fax: 301-585-6289
Mailing address:
  • Phone: 240-499-2636
  • Fax: 240-499-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125050377
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0074904
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: