Provider Demographics
NPI:1306188495
Name:PETROS ASSEFA AYELE
Entity Type:Organization
Organization Name:PETROS ASSEFA AYELE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PETROS
Authorized Official - Middle Name:
Authorized Official - Last Name:AYELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-659-0651
Mailing Address - Street 1:17601 HARPERS FERRY DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2029
Mailing Address - Country:US
Mailing Address - Phone:703-659-0651
Mailing Address - Fax:
Practice Address - Street 1:17601 HARPERS FERRY DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2029
Practice Address - Country:US
Practice Address - Phone:703-659-0651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242641261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care