Provider Demographics
NPI:1568097855
Name:ANDEMARIAM, SAMSON AFWERKI
Entity Type:Individual
Prefix:
First Name:SAMSON
Middle Name:AFWERKI
Last Name:ANDEMARIAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 E WEST HWY APT 103
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2407
Mailing Address - Country:US
Mailing Address - Phone:202-415-0312
Mailing Address - Fax:
Practice Address - Street 1:1913 E WEST HWY APT 103
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2407
Practice Address - Country:US
Practice Address - Phone:202-415-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC55214374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide