Provider Demographics
NPI:1568676294
Name:ASRES, BETHEL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETHEL
Middle Name:
Last Name:ASRES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 KINDLER OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2082
Mailing Address - Country:US
Mailing Address - Phone:301-760-0789
Mailing Address - Fax:
Practice Address - Street 1:7600 KINDLER OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2082
Practice Address - Country:US
Practice Address - Phone:301-760-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant