MEDICARE: SAMSON AFWERKI ANDEMARIAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	55214	DC

General Provider Information

NPI Number	:	1568097855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMSON AFWERKI ANDEMARIAM

Provider Business Mailing Address
First Line	:	1913 E WEST HWY APT 103
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2407
Country	:	US
Telephone Number	:	202-415-0312
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 E WEST HWY APT 103
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2407
Country	:	US
Telephone Number	:	202-415-0312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	03/06/2020

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