Provider Demographics
NPI:1750338075
Name:DEGENE, AKLILU MERSHA (MD)
Entity type:Individual
Prefix:
First Name:AKLILU
Middle Name:MERSHA
Last Name:DEGENE
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-5791
Mailing Address - Fax:540-433-4123
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5600
Practice Address - Fax:540-689-5601
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238021207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1000870001OtherDME PROVIDER
321619OtherSOUTHERN HEALTH
VA96956OtherOPTIMA
179962OtherANTHEM/BCBS
3810002958OtherWV MEDICAID
VA010173639Medicaid
3364824OtherCIGNA
VAP00234595OtherRAILROAD MEDICARE
VA010173639Medicaid
3810002958OtherWV MEDICAID
VA007758R83Medicare PIN