Provider Demographics
NPI:1396808705
Name:GETACHEW, ASRESAHGN M (MD)
Entity type:Individual
Prefix:MR
First Name:ASRESAHGN
Middle Name:M
Last Name:GETACHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 MERCANTILE LN
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5341
Mailing Address - Country:US
Mailing Address - Phone:301-925-7022
Mailing Address - Fax:301-925-4463
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:SUITE 180
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-925-7022
Practice Address - Fax:301-925-4463
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0042804261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD651191100Medicaid
MDG44478Medicare UPIN