{
"Npi": {
"NPI": "1588724009",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ASRESAHEGN",
"FirstName": "MESKEREM",
"MiddleName": null,
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15905 WILLIS WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODBINE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21797-7521",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-704-7554",
"MailingAddressFaxNumber": "301-925-4463",
"FirstLinePracticeLocationAddress": "1400 MERCANTILE LN",
"SecondLinePracticeLocationAddress": "SUITE 180",
"PracticeLocationAddressCityName": "LARGO",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20774-5341",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "301-925-7022",
"PracticeLocationAddressFaxNumber": "301-925-4463",
"EnumerationDate": "12/12/2006",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "D0053772",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}