Provider Demographics
NPI:1275646234
Name:GEBRESELASSIE, MILLEN WORKU (MD)
Entity Type:Individual
Prefix:DR
First Name:MILLEN
Middle Name:WORKU
Last Name:GEBRESELASSIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 S BROAD ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1613
Mailing Address - Country:US
Mailing Address - Phone:215-685-6769
Mailing Address - Fax:215-685-6732
Practice Address - Street 1:1900 N 20TH ST
Practice Address - Street 2:HEALTH CARE CENTER #5
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-2217
Practice Address - Country:US
Practice Address - Phone:215-685-2933
Practice Address - Fax:215-765-2409
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGE1689806Medicare ID - Type Unspecified
PAI21210Medicare UPIN
PA1013814050001Medicare ID - Type Unspecified