Healthcare Provider Details

I. General information

NPI: 1245292713
Provider Name (Legal Business Name): ASTER DERAR GHEBREMEDHIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6324 FAIRVIEW RD STE 350 SUITE 350
CHARLOTTE NC
28210-4171
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-8600
  • Fax: 704-384-8610
Mailing address:
  • Phone: 704-384-8600
  • Fax: 704-384-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9300124
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: