Provider Demographics
NPI:1407961782
Name:ASTER ASSEFA, MD, PC
Entity Type:Organization
Organization Name:ASTER ASSEFA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASTER
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSEFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-547-3030
Mailing Address - Street 1:603 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1006
Mailing Address - Country:US
Mailing Address - Phone:724-547-3030
Mailing Address - Fax:724-547-4596
Practice Address - Street 1:603 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1006
Practice Address - Country:US
Practice Address - Phone:724-547-3030
Practice Address - Fax:724-547-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019211110002Medicaid
PA0019211110002Medicaid