Healthcare Provider Details

I. General information

NPI: 1831170794
Provider Name (Legal Business Name): DAGNACHEW ASSEFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 303
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

5875 BREMO RD STE 303
RICHMOND VA
23226-1934
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8303
  • Fax:
Mailing address:
  • Phone: 804-281-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number0101257627
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number0101257627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: