Provider Demographics
NPI:1982822847
Name:BETESELASSIE, NEBIYU METAFERIA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEBIYU
Middle Name:METAFERIA
Last Name:BETESELASSIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7253 AMBASSADOR ROAD
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2710
Mailing Address - Country:US
Mailing Address - Phone:443-436-1116
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:127 W 10TH ST
Practice Address - Street 2:202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64105-1761
Practice Address - Country:US
Practice Address - Phone:816-404-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00720992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology