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1962994616 NPI number — ESUBALEW TADESSE AMERA

NPI Number: 1962994616
Health Care Provider/Practitioner: ESUBALEW TADESSE AMERA

Information about “1962994616” NPI (ESUBALEW TADESSE AMERA) exists in 1962994616 in HTML format HTML  |  1962994616 in plain Text format TXT  |  1962994616 in PDF (Portable Document Format) PDF  |  1962994616 in an XML format XML  formats.

NPI Number : 1962994616 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962994616",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AMERA",
    "FirstName": "ESUBALEW",
    "MiddleName": "TADESSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5403 ROBINSON LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILLIAMSBURG",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23188-2920",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-272-6331",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5403 ROBINSON LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILLIAMSBURG",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23188-2920",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-272-6331",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/30/2018",
    "LastUpdateDate": "05/30/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "347C00000X",
          "TaxonomyName": "Private Vehicle",
          "LicenseNumber": "901731",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "343900000X",
          "TaxonomyName": "Non-emergency Medical Transport (VAN)",
          "LicenseNumber": "901731",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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