Provider Demographics
NPI:1639612997
Name:AJEBE, MERON (PA-C)
Entity Type:Individual
Prefix:
First Name:MERON
Middle Name:
Last Name:AJEBE
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 1:42967 SPYDER PL
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3480
Mailing Address - Country:US
Mailing Address - Phone:571-331-0539
Mailing Address - Fax:
Practice Address - Street 1:42967 SPYDER PL
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-3480
Practice Address - Country:US
Practice Address - Phone:571-331-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant