Provider Demographics
NPI:1134480858
Name:ABERRA, FASIKA BERHANU (MD)
Entity Type:Individual
Prefix:
First Name:FASIKA
Middle Name:BERHANU
Last Name:ABERRA
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-5800
Mailing Address - Fax:833-552-3026
Practice Address - Street 1:130 HOSPITAL RD STE 300
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4057
Practice Address - Country:US
Practice Address - Phone:410-535-4333
Practice Address - Fax:410-535-3260
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51366208M00000X, 207R00000X
MDD96613207RG0100X
VA0101266585207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134480858Medicaid
TNPENDINGOtherBCBST
MD267416500Medicaid
TNPENDINGOtherRAIL ROAD MEDICARE
TNPENDINGMedicaid