Provider Demographics
NPI:1417117201
Name:ANSERA, HABTEMARIAM MEKONEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HABTEMARIAM
Middle Name:MEKONEN
Last Name:ANSERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S GEORGE MASON DR UNIT C1N
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-4722
Mailing Address - Country:US
Mailing Address - Phone:571-431-6426
Mailing Address - Fax:571-431-6428
Practice Address - Street 1:3701 S GEORGE MASON DR
Practice Address - Street 2:SUITE C-1-N
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3758
Practice Address - Country:US
Practice Address - Phone:571-431-6426
Practice Address - Fax:571-431-6428
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067614207V00000X
VA0101246339207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD019352600Medicaid
VA1417117201Medicaid