Provider Demographics
NPI:1588724009
Name:ASRESAHEGN, MESKEREM (MD)
Entity type:Individual
Prefix:MRS
First Name:MESKEREM
Middle Name:
Last Name:ASRESAHEGN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 WILLIS WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-7521
Mailing Address - Country:US
Mailing Address - Phone:301-704-7554
Mailing Address - Fax:301-925-4463
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:SUITE 180
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-925-7022
Practice Address - Fax:301-925-4463
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053772261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG85612Medicare UPIN
MDGE712883Medicare ID - Type Unspecified