Provider Demographics
NPI:1972852390
Name:ABERA, MESFIN TAYE (MD)
Entity Type:Individual
Prefix:
First Name:MESFIN
Middle Name:TAYE
Last Name:ABERA
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 1:3015 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5418
Mailing Address - Country:US
Mailing Address - Phone:605-725-1783
Mailing Address - Fax:605-725-1761
Practice Address - Street 1:3015 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-725-1783
Practice Address - Fax:605-725-1761
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116024419390200000X
SD9554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program