1699129213 NPI number — GIRMAY TEWOLDEMEDHN ASGEDOM M.D , M.S.P.H

Table of content: GIRMAY TEWOLDEMEDHN ASGEDOM M.D , M.S.P.H (NPI 1699129213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699129213 NPI number — GIRMAY TEWOLDEMEDHN ASGEDOM M.D , M.S.P.H

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASGEDOM
Provider First Name:
GIRMAY
Provider Middle Name:
TEWOLDEMEDHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D , M.S.P.H
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASGEDOM
Provider Other First Name:
GIRMAY
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699129213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 E NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15212-4756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-359-3030
Provider Business Mailing Address Fax Number:
412-359-3060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 E NORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15212-4756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-359-3030
Provider Business Practice Location Address Fax Number:
412-359-3060
Provider Enumeration Date:
04/20/2016

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: 207R00000X , with the licence number:  0101266754 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: FA0151263 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 0101266754 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD476180 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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