Provider Demographics
NPI:1013953579
Name:WOLDESENBET, MESFIN (MD)
Entity Type:Individual
Prefix:
First Name:MESFIN
Middle Name:
Last Name:WOLDESENBET
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 1:12802 EAGLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1187
Mailing Address - Country:US
Mailing Address - Phone:281-638-0047
Mailing Address - Fax:281-638-0047
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:240-826-7392
Practice Address - Fax:240-826-5388
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5956208000000X, 2080N0001X
MDD755442080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163136803Medicaid
TX163136804OtherCSHCN
TX8K9797OtherBCBS