Provider Demographics
NPI:1578732665
Name:AFETA, GIFTY (MD)
Entity Type:Individual
Prefix:
First Name:GIFTY
Middle Name:
Last Name:AFETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST STE 1204
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:240-499-2636
Mailing Address - Fax:240-499-2602
Practice Address - Street 1:8210 COLONIAL LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5721
Practice Address - Country:US
Practice Address - Phone:301-586-1250
Practice Address - Fax:301-585-6289
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050377208000000X
MDD0074904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD130061000Medicaid