=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174000756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEWAY KASSAHUN ESHETE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2018
-----------------------------------------------------
Last Update Date | 09/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 726 UNIVERSITY BLVD W
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-918-3720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 726 UNIVERSITY BLVD W
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-918-3720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | E230626461734
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------