Provider Demographics
NPI:1407953219
Name:ASHEBIR WOLDEABEZGI MD PC
Entity Type:Organization
Organization Name:ASHEBIR WOLDEABEZGI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHEBIR
Authorized Official - Middle Name:GEBRU
Authorized Official - Last Name:WOLDEABEZGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-374-9725
Mailing Address - Street 1:11637 TERRACE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3706
Mailing Address - Country:US
Mailing Address - Phone:301-374-9725
Mailing Address - Fax:301-374-9724
Practice Address - Street 1:11637 TERRACE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3706
Practice Address - Country:US
Practice Address - Phone:301-374-9725
Practice Address - Fax:301-374-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
265824OtherKAISER PERMANETE
2159246OtherMDIPA
DG0925OtherMEDICARE RAILROAD
MD29JGAOtherBCBS CAREFIRST
7031OtherCAREFIRST FEDERAL
1419486OtherAETNA HMO
7223718OtherAETNA
2159246OtherMAMSI LIFE AND HEALTH
207251OtherJOHNS HOPKINS MED SERVICE
2159246OtherALLIANCE
248267OtherANTHEM
265824OtherKAISER PERMANETE
7031OtherCAREFIRST FEDERAL
2159246OtherMDIPA
7031OtherCAREFIRST FEDERAL