1083629968 NPI number — GETACHEW AFRE MD

Table of content: GETACHEW AFRE MD (NPI 1083629968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083629968 NPI number — GETACHEW AFRE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AFRE
Provider First Name:
GETACHEW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083629968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8802 SUMNER GROVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20708-3539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-723-4448
Provider Business Mailing Address Fax Number:
202-723-4494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6323 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20011-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-723-4448
Provider Business Practice Location Address Fax Number:
202-723-4494
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD30689 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: MD30689 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017122800 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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