Provider Demographics
NPI:1407275357
Name:ESHETU, NEBIYU ABIY (MD)
Entity Type:Individual
Prefix:
First Name:NEBIYU
Middle Name:ABIY
Last Name:ESHETU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NEBIYU
Other - Middle Name:
Other - Last Name:ABIY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1124 MACE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3315
Mailing Address - Country:US
Mailing Address - Phone:410-391-6996
Mailing Address - Fax:410-687-6877
Practice Address - Street 1:1124 MACE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3315
Practice Address - Country:US
Practice Address - Phone:410-391-6996
Practice Address - Fax:410-687-6877
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460824207R00000X
MDD0084914207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program