Provider Demographics
NPI:1588853972
Name:GHEBREKIDAN, HABTE DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HABTE
Middle Name:DANIEL
Last Name:GHEBREKIDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-4005
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437433207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2114884OtherHIGHMARK BLUE SHIELD
PA30131966OtherAMERIHEALTH MERCY - WMG
PA102333028Medicaid
PA953937OtherCAREFIRST MD BCBS-WMG
MD033820600Medicaid
PA1582725OtherGATEWAY-WMG
PA277833OtherUNISON
PA20091554OtherAMERIHEALTH MERCY-WMG
PA1582725OtherGATEWAY-WMG
PA277833OtherUNISON
PA102333028Medicaid