Provider Demographics
NPI:1083629968
Name:AFRE, GETACHEW (MD)
Entity Type:Individual
Prefix:
First Name:GETACHEW
Middle Name:
Last Name:AFRE
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 1:8802 SUMNER GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3539
Mailing Address - Country:US
Mailing Address - Phone:202-723-4448
Mailing Address - Fax:202-723-4494
Practice Address - Street 1:6323 GEORGIA AVE NW
Practice Address - Street 2:STE 106
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1101
Practice Address - Country:US
Practice Address - Phone:202-723-4448
Practice Address - Fax:202-723-4494
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30689261QP2300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017122800Medicaid
DC490032Medicare ID - Type Unspecified
DC017122800Medicaid