Provider Demographics
NPI:1841904992
Name:MEHARI, SIMON
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:MEHARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 LARRY DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5714
Mailing Address - Country:US
Mailing Address - Phone:717-343-9311
Mailing Address - Fax:
Practice Address - Street 1:3233 LARRY DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5714
Practice Address - Country:US
Practice Address - Phone:717-343-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000000Medicaid