Provider Demographics
NPI:1962760199
Name:FREW, MESFIN T (PA)
Entity type:Individual
Prefix:
First Name:MESFIN
Middle Name:T
Last Name:FREW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12522 VEIRS MILL RD APT 104
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3525
Mailing Address - Country:US
Mailing Address - Phone:301-222-3668
Mailing Address - Fax:
Practice Address - Street 1:755 WATERLOO ROAD
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794
Practice Address - Country:US
Practice Address - Phone:410-799-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant