Provider Demographics
NPI:1417912593
Name:ASMAMAW, ABRAHAM YIMER (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:YIMER
Last Name:ASMAMAW
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:PO BOX 11529
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-0529
Mailing Address - Country:US
Mailing Address - Phone:703-820-8050
Mailing Address - Fax:703-820-8720
Practice Address - Street 1:4600 KING ST
Practice Address - Street 2:STE 4R
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1277
Practice Address - Country:US
Practice Address - Phone:703-820-8050
Practice Address - Fax:703-820-8720
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223994208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10006171Medicaid
VA00V618I46Medicare PIN
VA10006171Medicaid
G93995Medicare UPIN