Provider Demographics
NPI:1831358480
Name:ABEBE, ELIAS WOLDETSADIK (MD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:WOLDETSADIK
Last Name:ABEBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2613
Mailing Address - Fax:717-798-3677
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2613
Practice Address - Fax:717-798-3677
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4566482080N0001X
MDD680552080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031129070001Medicare PIN
PA479468FLTMedicare PIN
MD419396201Medicare PIN