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General NPI Number Information
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NPI Number | 1417117201
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Entity Type | Individual
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Provider Name | HABTEMARIAM MEKONEN ANSERA MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2008
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Last Update Date | 09/14/2019
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Provider Practice Location Address
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Address Line | 3701 S GEORGE MASON DR SUITE C-1-N
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City | FALLS CHURCH
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State | VA
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Zip | 22041-3758
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Country | US
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Telephone | 571-431-6426
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Fax | 571-431-6428
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Provider Business Mailing Address
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Address Line | 3701 S GEORGE MASON DR UNIT C1N
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City | FALLS CHURCH
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State | VA
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Zip | 22041-4722
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Country | US
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Telephone | 571-431-6426
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Fax | 571-431-6428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D0067614
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101246339
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License Number State | VA
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