Provider Demographics
NPI:1437653904
Name:GIRMA, AEDOME (DO)
Entity Type:Individual
Prefix:DR
First Name:AEDOME
Middle Name:
Last Name:GIRMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SPRING ST APT 11
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3949
Mailing Address - Country:US
Mailing Address - Phone:617-335-5096
Mailing Address - Fax:617-415-2769
Practice Address - Street 1:185 DEVONSHIRE ST STE 500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1407
Practice Address - Country:US
Practice Address - Phone:617-356-7112
Practice Address - Fax:617-415-2769
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2908502084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program