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General NPI Number Information
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NPI Number | 1306188495
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Entity Type | Organization
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Legal Business Name | PETROS ASSEFA AYELE
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 17601 HARPERS FERRY DR
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City | DUMFRIES
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State | VA
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Zip | 22025-2029
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Country | US
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Telephone | 703-659-0651
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Fax |
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Provider Business Mailing Address
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Address Line | 17601 HARPERS FERRY DR
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City | DUMFRIES
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State | VA
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Zip | 22025-2029
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Country | US
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Telephone | 703-659-0651
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | PETROS AYELE
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Credential | MD
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Telephone | 703-659-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101242641
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License Number State | VA
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