Provider Demographics
NPI:1750714036
Name:AZEREFEGN, HAILEMICHAEL ASCHENAKI (PA)
Entity type:Individual
Prefix:
First Name:HAILEMICHAEL
Middle Name:ASCHENAKI
Last Name:AZEREFEGN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 BEL PRE RD
Mailing Address - Street 2:24
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2670
Mailing Address - Country:US
Mailing Address - Phone:301-281-5193
Mailing Address - Fax:
Practice Address - Street 1:3650 BEL PRE RD
Practice Address - Street 2:24
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2670
Practice Address - Country:US
Practice Address - Phone:301-281-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant