Provider Demographics
NPI:1598794646
Name:WOLDEABEZGI, ASHEBIR GEBRU (MD)
Entity Type:Individual
Prefix:
First Name:ASHEBIR
Middle Name:GEBRU
Last Name:WOLDEABEZGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11637 TERRACE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3706
Mailing Address - Country:US
Mailing Address - Phone:301-374-9725
Mailing Address - Fax:301-374-9181
Practice Address - Street 1:11637 TERRACE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3706
Practice Address - Country:US
Practice Address - Phone:301-374-9725
Practice Address - Fax:301-374-9181
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062596207RI0200X, 207R00000X
VA0101240403207RI0200X, 207R00000X
DCMD035472207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
265824OtherKAISER PERMANENTE
313733OtherAMERIGROUP
MD4124120000OtherMARYLAN PHYSICAN CARE
2152946OtherMAMSI LIFE AND HEALTH
P00414839OtherMEDICARE RAILROAD
2159246OtherMDIPA
MD412412000Medicaid
VA010347505Medicaid
010874247OtherCIGNA
VA248272OtherANTHEM
7223718OtherAETNA
207251OtherJOHNS HOPKINS MED SERVICE
2159246OtherONENET
6023OtherBRAVO
70310001OtherBLUE CROSS BLUE SHIELD
1419486OtherAETNA HMO
MD89335301OtherBCBS OF MARYLAND CAREFIRS
P00414839OtherMEDICARE RAILROAD
1419486OtherAETNA HMO
MD362P744GMedicare PIN