1255336962 NPI number — DR. TSION BERHANE MD

Table of content: DR. TSION BERHANE MD (NPI 1255336962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255336962 NPI number — DR. TSION BERHANE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERHANE
Provider First Name:
TSION
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1255336962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 MISSION HILLS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20905-8020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-997-5944
Provider Business Mailing Address Fax Number:
443-445-3392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 MISSION HILLS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20905-8020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-997-5944
Provider Business Practice Location Address Fax Number:
443-445-3392
Provider Enumeration Date:
06/17/2005

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: 2086S0102X , with the licence number:  D0055703 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: D0055703 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003501700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: GS3108342 . This is a "MAMSI GEN'L SURGERY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: CC2108342 . This is a "MAMSI CRITICAL CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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