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General NPI Number Information
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NPI Number | 1588724009
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Entity Type | Individual
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Provider Name | MESKEREM ASRESAHEGN M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 MERCANTILE LN SUITE 180
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City | LARGO
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State | MD
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Zip | 20774-5341
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Country | US
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Telephone | 301-925-7022
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Fax | 301-925-4463
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Provider Business Mailing Address
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Address Line | 15905 WILLIS WAY
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City | WOODBINE
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State | MD
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Zip | 21797-7521
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Country | US
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Telephone | 301-704-7554
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Fax | 301-925-4463
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | D0053772
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License Number State | MD
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