Provider Demographics
NPI:1528364213
Name:ASFAW, ASFAWOSSEN B (MD)
Entity Type:Individual
Prefix:MR
First Name:ASFAWOSSEN
Middle Name:B
Last Name:ASFAW
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1613 N HARRISON PARKWAY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:809 82ND PARKWAY
Practice Address - Street 2:GRAND STAND REGIONAL MEDICAL CENTER
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572
Practice Address - Country:US
Practice Address - Phone:843-692-1750
Practice Address - Fax:954-851-1746
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2015-09-02
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Provider Licenses
StateLicense IDTaxonomies
SCTL38364208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics